The evaluation of screening policies for diabetic retinopathy using simulation

Davies, Ruth; Roderick, Paul; Canning, C R; Brailsford, Sally C.

doi:10.1046/j.1464-5491.2002.00773.x

Cited by 48 publications

(61 citation statements)

References 58 publications

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“…However, in contrast to these two studies, another UK study by Davies et al 48 found that screening diabetic patients less than once a year would not be any more cost-effective than every year. Davies et al 48 also based their study on a decision analytic model populated using results obtained from the published literature. A finding common in both UK studies was that screening of type 1 diabetes patients was more cost-effective than screening of type 2 diabetes patients.…”

Section: Introductionmentioning

confidence: 69%

“…The study, which also used a decision analytic model to assess the cost-effectiveness of DR screening in both type 1 and type 2 diabetes patients, found that a 30-month screening interval was the most cost-effective option. However, in contrast to these two studies, Davies et al 48 found that screening diabetic patients less than once a year would not be any more cost-effective than screening them every year. The study also based its work on a decision analytic model populated using results obtained from the published literature.…”

Section: Existing Researchmentioning

confidence: 83%

See 1 more Smart Citation

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

106

167

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BackgroundThe English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.ObjectivesTo determine whether personalised screening intervals are cost-effective.DesignRisk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium–low, medium–high or high risk). The risk factor models were validated in other populations.SettingGloucestershire, Nottinghamshire, South London and East Anglia (all UK).ParticipantsPeople with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.Main outcome measuresPersonalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.ResultsData were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43 –48% while screening high-risk groups every 2 years was cost-effective with a probability of 55–59%.ConclusionsThe study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading.Study registrationIntegrated Research Application System project number 118959.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Introductionmentioning

confidence: 69%

Section: Existing Researchmentioning

confidence: 83%

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

106

167

View full text Add to dashboard Cite

show abstract

“…Such models incorporate a number of assumptions including prevalence, incidence and natural history of diabetes and DR, screening sensitivity and specificity, patient compliance, and treatment efficacy. Davies et al modelled screening strategies to determine cost-effectiveness in a population of 500,000 821 . Standard methods of screening save up to 50% of the sight years potentially lost.…”

Section: International Datamentioning

confidence: 99%

“…An idealised gold standard program using mydriatic seven-field photography reported by an ophthalmologist save up to 85% of sight years potentially lost. Screening by a mobile camera (one photo reviewed by a diabetologist) gave the lowest cost of sight years saved (£2842) 821 . It is less effective to screen type 2 than type 1 diabetes patients, but type 2 patients contributed to almost three-quarters of the sight years saved.…”

Section: International Datamentioning

confidence: 99%

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

Foreman

Keel

Xie

et al. 2017

Medical Journal of Australia

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“…Although the cumulative risk of retinopathy is substantial in type I DM, reaching up to 60% for sightthreatening disease over 20 years, the overall burden of preventable blindness secondary to type II DM is greater, because its prevalence is higher. 1,2 The prevalence of DM, particularly type II DM, is rising throughout the world and especially in developed countries. 3 In England and Wales, diabetic retinopathy remains the most common cause of blindness registration among people of working age.…”

Section: Introductionmentioning

confidence: 99%