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Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening.
- Source :
-
The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2020 Sep; Vol. 21 (7), pp. 993-1002. Date of Electronic Publication: 2020 May 08. - Publication Year :
- 2020
-
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).<br />Setting: Diabetic Eye Screening Wales (DESW).<br />Study Design: Retrospective observational study with cost-utility analysis (CUA) and Decremental Cost-Effectiveness Ratios (DCER) study.<br />Intervention: Biennial screening versus usual care (annual screening).<br />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.<br />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 <subscript>1c</subscript> was 7.5% for those with T2DM and 8.7% for T1DM.<br />Sensitivity Analysis: Extending screening to biennial based on HbA <subscript>1c</subscript> , being the strongest predictor of progression of DR, at three levels of HbA <subscript>1c</subscript> 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.<br />Conclusions: Base case and sensitivity analyses indicate biennial screening to be cost-effective for T2DM irrespective of HbA <subscript>1c</subscript> 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 <subscript>1c</subscript> exceeds 80 mmol/mol (9.5%) and duration of diabetes is greater than 12 years.
- Subjects :
- Adult
Aged
Cost-Benefit Analysis
Female
Glycated Hemoglobin
Health Expenditures statistics & numerical data
Health Resources economics
Humans
Male
Markov Chains
Middle Aged
Models, Econometric
Quality-Adjusted Life Years
Retrospective Studies
Risk Factors
Social Work economics
Time Factors
Diabetes Mellitus, Type 1 complications
Diabetes Mellitus, Type 2 complications
Diabetic Retinopathy diagnosis
Mass Screening economics
Subjects
Details
- Language :
- English
- ISSN :
- 1618-7601
- Volume :
- 21
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The European journal of health economics : HEPAC : health economics in prevention and care
- Publication Type :
- Academic Journal
- Accession number :
- 32385543
- Full Text :
- https://doi.org/10.1007/s10198-020-01191-y