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Modelling the cost‐effectiveness of adopting risk‐stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland
Author(s) -
Scotland G.,
McKeigue P.,
Philip S.,
Leese G. P.,
Olson J. A.,
Looker H. C.,
Colhoun H. M.,
Javanbakht M.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13129
Subject(s) - medicine , retinopathy , diabetic retinopathy , cohort , quality adjusted life year , population , cohort study , cost effectiveness , demography , diabetes mellitus , pediatrics , optometry , environmental health , risk analysis (engineering) , endocrinology , sociology
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 a covariate distribution matching that of the Scottish diabetic screening population. The cost‐effectiveness of adopting extended (2–year) screening for groups with no observed retinopathy 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 quality‐adjusted life year gained for annual vs. biennial screening ranged from approximately £74 000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to approximately £232 000 per quality‐adjusted life year 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; approximately £22 000 to £85 000 per quality‐adjusted life year 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.