Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening

Abstract

Objective Examine the health and economic impact of extending screening intervals in people with Type 2 diabetes (T2DM) and Type 1 diabetes (T1DM) without diabetes-related retinopathy (DR). Setting Diabetic Eye Screening Wales (DESW). Study design Retrospective observational study with cost-utility analysis (CUA) and Decremental Cost-Effectiveness Ratios (DCER) study. Intervention Biennial screening versus usual care (annual screening). Inputs Anonymised data from DESW were linked to primary care data for people with two prior screening events with no DR. Transition probabilities for progression to DR were estimated based on a subset of 26,812 and 1232 people with T2DM and T1DM, respectively. DCER above £20,000 per QALY was considered cost-effective. Results The base case analysis DCER results of £71,243 and £23,446 per QALY for T2DM and T1DM respectively at a 3.5% discount rate and £56,822 and £14,221 respectively when discounted at 1.5%. Diabetes management represented by the mean HbA 1c was 7.5% for those with T2DM and 8.7% for T1DM. Sensitivity analysis Extending screening to biennial based on HbA 1c , being the strongest predictor of progression of DR, at three levels of HbA 1c 6.5%, 8.0% and 9.5% lost one QALY saving the NHS £106,075; £58,653 and £31,626 respectively for T2DM and £94,696, £37,646 and £11,089 respectively for T1DM. In addition, extending screening to biennial based on the duration of diabetes > 6 years for T2DM per QALY lost, saving the NHS £54,106 and for 6-12 and > 12 years for T1DM saving £83,856, £23,446 and £13,340 respectively. Conclusions Base case and sensitivity analyses indicate biennial screening to be cost-effective for T2DM irrespective of HbA 1c and duration of diabetes. However, the uncertainty around the DCER indicates that annual screening should be maintained for those with T1DM especially when the HbA 1c exceeds 80 mmol/mol (9.5%) and duration of diabetes is greater than 12 years.

Biennial diabetic eye screening: unveiling ethnic and age-related disparities in delayed diagnosis

“…This study presents critical insights into the implications of extending intervals for diabetic eye screening, especially among multiethnic populations 1. Research suggests extending screening intervals to biennial for low-risk patients may be cost-effective but calls for caution due to varying risk definitions and patient adherence 2. Additional findings highlight the importance of considering ethnic-specific prevalence and variations in visual impairment, suggesting significant roles of genetic, lifestyle and healthcare access differences in the progression of DR 3.…”

Cost-effectiveness of artificial intelligence screening for diabetic retinopathy in rural China

“…Additionally, the data on detailed costs for AI screening conducted in rural China, especially indirect costs (i.e., the income loss of patients’ family associated with their blindness) and the compliance of screening and follow-up examination should be investigated. Moreover, screening intervals have been found to have influence on cost-effectiveness in many countries [ 43 – 47 ]. Since we used screening intervals recommended by ICO guidelines for diabetic eye care, individualized screening intervals suitable for Chinese patients should be investigated.…”

An Economic Analysis for the Use of Artificial Intelligence in Screening for Diabetic Retinopathy in Trinidad and Tobago

“…They estimated the cost to the Korean healthcare system at US$384,000 per 10,000 diabetics screened. Thomas et al described resource utilization of screening and the impact of DR treatment in Wales [ 22 ]. Derived from multiple sources, the data show that the cost of hospital-based screening was approximately one-tenth of the cost of surgical intervention (vitrectomy) and less than 2% of the cost of sight loss to a person living in a care home.…”