Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists

Katwyk, Sasha van; Jin, Ya-Ping; Trope, Graham E.; Buys, Yvonne M.; Masucci, Lisa; Wedge, Richard; Flanagan, John G.; Brent, Michael H.; El‐Defrawy, Sherif; Tu, Hong; Thavorn, Kednapa

doi:10.1016/j.jval.2017.04.015

Cited by 12 publications

(8 citation statements)

References 12 publications

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“…Systematic photography can be potentially cost-effective since it can save the direct examination cost by the ophthalmologist. For example, extending public health coverage to eye examination by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY [ 44 ]. Our study shows that the addition of digital retinal fundus photography to regular health examination by NHI is highly cost-effective screening method.…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea

Song

Choi

et al. 2018

PLoS ONE

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BackgroundInterventions that can facilitate early diagnosis of age-related macular degeneration (AMD) will facilitate early treatment and improve clinical outcomes but there has been concerns about additional medical costs to the health care system. An examination through a retina fundus photography by a non-specialist has been suggested as a potential cost-effective alternative to a direct examination by a specialist, but limited scientific data exists on the cost-effectiveness of screening strategies for AMD. Our objective is to conduct an economic evaluation of various population-wide screening strategies for AMD among the South Korean population.Methods and findingsUsing a Markov cohort model, we evaluated the cost-effectiveness of four AMD screening strategies (opportunistic examination, opportunistic treatment, systematic photography, and systematic examination) in comparison with status quo (no screening) for South Korean adults. We projected a life time horizon to study a hypothetical cohort of 100,00 persons of age 40 with and without AMD at baseline. The outcome measures were quality-adjusted life-years (QALYs) gained, cost from the societal perspective, and the incremental cost-effectiveness ratio (ICER) of each strategy. Interventions were evaluated at a willingness-to-pay (WTP) threshold of 30,000,000 KRW ($27,538) per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to address the model uncertainty. Opportunistic examination was strongly dominated because it generated fewer expected QALYs but incurred greater expected cost than the other screening strategies. The mean lifetime expected costs were 289,013 KRW, 363,692 KRW, 9,351,964 KRW, and 12,309,783 KRW, and the mean QALYs gained were 37.73, 37.75, 40.47, 40.68, for no screening, opportunistic treatment, systematic photography, and systematic examination, respectively. The results were most sensitive to the utility weight of mild AMD, the probability of complication from treatment, the cost of being in mild AMD, and the probability of recovery from complication. After eliminating the two weakly dominated strategies, systematic photography was cost-effective at the ICER of 3,310,448 KRW per QALY in comparison to status quo.ConclusionsUnder the WTP threshold of 30,000,000 KRW per QALY, systematic photography is cost-effective for screening AMD in South Korean adults. Systematic examination by ophthalmologists generates more expected QALY and cost compared to systematic photography.

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Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea

Song

Choi

et al. 2018

PLoS ONE

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“…Fecal immunology test 2. gFOBT 3. Sigmoidoscopy Each other Screening-naive subjects ages 50 to 74 years, living in the southwest of the Netherlands Lifetime Healthcare 3% 2012 EUR Positivity rates, detection of adenoma and CRC, QALYs Yes Screening stratified by gender is not more CE than uniform FIT screening NA Yes van Katwyk et al [ 53 ] Canada Diabetic retinopathy Extended coverage of diabetic eye examination Usual care Prince Edward Island residents over 45 years of age who had diabetes 30 years Healthcare 5% 2015 CAD QALYs Yes Extending public health coverage to eye examinations by optometrists is CE CIHR Yes van Luijt et al [ 67 ] Norway Breast cancer Mammography No screening Norway female population Lifetime Societal 4% 2014 NOK QALYs No The NBCSP is a highly CE measure to reduce breast cancer specific mortality Research Council Norway Yes Wang et al [ 17 ] China Chronic kidney disease 1. Day 1 2.…”

Section: Resultsmentioning

confidence: 99%

“…Health outcomes may be overestimated when assuming 100% accurate diagnostic tests. Alternatively, some studies assumed that diagnostic tests were not perfect and included costs and health consequences of the incorrect treatment of false positive patients, such as healthy patients receiving unnecessary treatment and having side effects [ 17 , 43 , 48 , 53 , 54 ]. Whenever a treatment poses a considerable threat to false positives (or a considerable monetary cost), CEAs should acknowledge and include these scenarios.…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, studies that modeled treatment pathways captured different health outcomes to evaluate cost-effectiveness of screening strategies. Quality-adjusted life years (QALYs) were estimated by 39 studies (57.3%) [ 12 – 15 , 17 , 18 , 21 , 27 , 28 , 32 – 35 , 37 , 39 , 40 , 42 , 45 – 51 , 53 – 57 , 59 , 62 , 65 , 67 – 69 , 72 , 74 – 78 ], and expected life years (ELYs) by 10 (14.7%) [ 18 , 19 , 36 , 43 , 52 , 58 , 65 , 66 , 79 , 80 ]. Utilities were widely used, and the following challenges and methodologies were reported: Chowers et al acknowledged having underestimated QALY outcomes in their prenatal HIV screening evaluation by excluding maternal utility measures.…”

Section: Resultsmentioning

confidence: 99%

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Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Iragorri

Spackman

2018

Public Health Rev

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BackgroundScreening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools.ObjectiveThis review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them.MethodsA systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized.ResultsFour key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early.ConclusionsTo capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.

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“…Diabetic retinopathy screening and treatment, such as laser treatment, eye injections and surgeries to prevent sight-threatening complications are of economic bene t [4][5][6][7]. However, retinopathy screening attendance rates are low in Canada.…”

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confidence: 99%

Assessing the feasibility, acceptability, and fidelity of a teleretinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: A protocol

Umaefulam

Wilson

Boucher

et al. 2023

Preprint

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Background: Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attended screening. Screening rates are even lower in immigrants to Canada including people from China, Africa and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally-tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. Methods: We will work with our health system and patient partners to conduct a six-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50-150 patients and 5-10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, we will use a survey informed by the National Institutes of Health Behaviour Change framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. Discussion: This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention.

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Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists

Abstract: Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes.

Cited by 12 publications

References 12 publications

The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea

The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea

Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis

Assessing the feasibility, acceptability, and fidelity of a teleretinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: A protocol

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