Abstract
Aims:
To assess the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland.
Methods:
A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (two-year) screening for groups identified as low risk was then assessed over a 30 year time horizon.
Results:
Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per QALY gained for annual versus biennial screening ranged from ~£74,000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to ~£232,000 per QALY gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; ~£22,000 to £85,000 per QALY gained respectively.
Conclusions:
Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.
To assess the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland.
Methods:
A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (two-year) screening for groups identified as low risk was then assessed over a 30 year time horizon.
Results:
Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per QALY gained for annual versus biennial screening ranged from ~£74,000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to ~£232,000 per QALY gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; ~£22,000 to £85,000 per QALY gained respectively.
Conclusions:
Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.
| Original language | English |
|---|---|
| Pages (from-to) | 886-895 |
| Number of pages | 10 |
| Journal | Diabetic Medicine |
| Volume | 33 |
| Issue number | 7 |
| Early online date | 11 May 2016 |
| DOIs | |
| Publication status | Published - Jul 2016 |
Bibliographical note
Funding sources: The study was funded by a research grant from the Chief Scientist’s Office of the Scottish Government Health and Social Care Directorates (CZH/4/971). The funder played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions. The views expressed herein are those of the authors and do not necessarily reflect those of the funder.Acknowledgements: The authors would like to thank Drs Vijay Hegde (NHS Grampian), William Wykes, Sonia Zachariah (NHS Glasgow), Karin Madill (NHS Lothian), Caroline Styles (NHS Fife), Mohan Varikkara (NHS Ayrshire and Arran), and Brian Power (NHS Dumfries and Galloway) for providing information on their current clinical practice for dealing with referrals from the diabetic retinopathy screening programme in Scotland.
Access to Document
- Accepted Manuscript
This is the peer reviewed version of the following article: Diabet. Med. 33: 886–895 (2016), which has been published in final form at DOI: 10.1111/dme.13129. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
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Graham Scotland
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Personal Chair
- Institute of Applied Health Sciences
Person: Academic