scholarly journals Modelling the cost-effectiveness of adopting risk-stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland

2016 ◽  
Vol 33 (7) ◽  
pp. 886-895 ◽  
Author(s):  
G. Scotland ◽  
P. McKeigue ◽  
S. Philip ◽  
G. P. Leese ◽  
J. A. Olson ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Cost Effectiveness ◽  
Screening Programme ◽  
Diabetic Retinopathy Screening ◽  
Screening Intervals ◽  
The Cost ◽  
Retinopathy Screening

scholarly journals Safety and cost-effectiveness of individualised screening for diabetic retinopathy: the ISDR open-label, equivalence RCT

Diabetologia ◽  
2020 ◽  
Vol 64 (1) ◽  
pp. 56-69 ◽  
Author(s):  
Deborah M. Broadbent ◽  
◽  
Amu Wang ◽  
Christopher P. Cheyne ◽  
Marilyn James ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Cost Effectiveness ◽  
National Health Service ◽  
Time Horizon ◽  
Screening Programme ◽  
Variable Interval ◽  
Diabetic Retinopathy Screening ◽  
Screening Intervals ◽  
Retinopathy Screening

Abstract Aims/hypothesis Using variable diabetic retinopathy screening intervals, informed by personal risk levels, offers improved engagement of people with diabetes and reallocation of resources to high-risk groups, while addressing the increasing prevalence of diabetes. However, safety data on extending screening intervals are minimal. The aim of this study was to evaluate the safety and cost-effectiveness of individualised, variable-interval, risk-based population screening compared with usual care, with wide-ranging input from individuals with diabetes. Methods This was a two-arm, parallel-assignment, equivalence RCT (minimum 2 year follow-up) in individuals with diabetes aged 12 years or older registered with a single English screening programme. Participants were randomly allocated 1:1 at baseline to individualised screening at 6, 12 or 24 months for those at high, medium and low risk, respectively, as determined at each screening episode by a risk-calculation engine using local demographic, screening and clinical data, or to annual screening (control group). Screening staff and investigators were observer-masked to allocation and interval. Data were collected within the screening programme. The primary outcome was attendance (safety). A secondary safety outcome was the development of sight-threatening diabetic retinopathy. Cost-effectiveness was evaluated within a 2 year time horizon from National Health Service and societal perspectives. Results A total of 4534 participants were randomised. After withdrawals, there were 2097 participants in the individualised screening arm and 2224 in the control arm. Attendance rates at first follow-up were equivalent between the two arms (individualised screening 83.6%; control arm 84.7%; difference −1.0 [95% CI −3.2, 1.2]), while sight-threatening diabetic retinopathy detection rates were non-inferior in the individualised screening arm (individualised screening 1.4%, control arm 1.7%; difference −0.3 [95% CI −1.1, 0.5]). Sensitivity analyses confirmed these findings. No important adverse events were observed. Mean differences in complete case quality-adjusted life-years (EuroQol Five-Dimension Questionnaire, Health Utilities Index Mark 3) did not significantly differ from zero; multiple imputation supported the dominance of individualised screening. Incremental cost savings per person with individualised screening were £17.34 (95% CI 17.02, 17.67) from the National Health Service perspective and £23.11 (95% CI 22.73, 23.53) from the societal perspective, representing a 21% reduction in overall programme costs. Overall, 43.2% fewer screening appointments were required in the individualised arm. Conclusions/interpretation Stakeholders involved in diabetes care can be reassured by this study, which is the largest ophthalmic RCT in diabetic retinopathy screening to date, that extended and individualised, variable-interval, risk-based screening is feasible and can be safely and cost-effectively introduced in established systematic programmes. Because of the 2 year time horizon of the trial and the long time frame of the disease, robust monitoring of attendance and retinopathy rates should be included in any future implementation. Trial registration ISRCTN 87561257 Funding The study was funded by the UK National Institute for Health Research.

Cost-Effectiveness Analysis of Non-Mydriatic Ultrawide- Field Fundus Photography versus Pharmacological Pupil Dilatation in Diabetic Retinopathy Screening Program

2021 ◽  
Vol 104 (5) ◽  
pp. 818-824
Keyword(s):  
Diabetic Retinopathy ◽  
Cost Effectiveness ◽  
Screening Program ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Fundus Photography ◽  
Diabetic Retinopathy Screening ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Retinopathy Screening

Background: Diabetic retinopathy (DR) causes blindness of the population in many countries worldwide. Early detection and treatment of this disease via a DR screening program is the best way to secure the vision. An annual screening program using pharmacological pupil dilatation becomes the standard method. Recently, non-mydriatic ultrawide-field fundus photography (UWF) has been proposed as a choice for DR screening. However, there was no cost-effectiveness study between the standard DR screening and this UWF approach. Objective: To compare the cost-effectiveness between UWF and pharmacological pupil dilatation in terms of hospital and societal perspectives. Materials and Methods: Patients with type 2 diabetes mellitus that visited the ophthalmology clinic at Chulabhorn Hospital for DR screening were randomized using simple randomization method. The patients were interviewed by a trained interviewer for general and economic information. The clinical characteristics of DR and staging were recorded. Direct medical costs, direct non-medical costs, and informal care costs due to DR screening were recorded. Cost analyses were calculated for the hospital and societal perspectives. Results: The present study presented the cost-effectiveness analyses of UWF versus pharmacological pupil dilatation. Cost-effectiveness analysis from the hospital perspective showed the incremental cost-effectiveness ratio (ICER) of UWF to be –13.87. UWF was a cost-effective mean in DR screening in the societal perspective when compared with pharmacologically pupil dilatation with the ICER of 76.46, under the threshold of willingness to pay. Conclusion: The UWF was a cost-effective mean in DR screening. It can reduce screening duration and bypass post-screening blurred vision. The results suggested that UWF could be a viable option for DR screening. Keywords: Diabetic retinopathy, Diabetic retinopathy screening, Non-mydriatic ultrawide-field fundus photography, Cost-effectiveness analysis

scholarly journals Predicted impact of extending the screening interval for diabetic retinopathy: the Scottish Diabetic Retinopathy Screening programme

Diabetologia ◽  
2013 ◽  
Vol 56 (8) ◽  
pp. 1716-1725 ◽  
Author(s):  
H. C. Looker ◽  
◽  
S. O. Nyangoma ◽  
D. T. Cromie ◽  
J. A. Olson ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Diabetic Retinopathy Screening ◽  
Screening Interval ◽  
Retinopathy Screening

Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore

Ophthalmology ◽  
2016 ◽  
Vol 123 (12) ◽  
pp. 2571-2580 ◽  
Author(s):  
Hai V. Nguyen ◽  
Gavin Siew Wei Tan ◽  
Robyn Jennifer Tapp ◽  
Shweta Mital ◽  
Daniel Shu Wei Ting ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Cost Effectiveness ◽  
Screening Program ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening

scholarly journals Can Commercially Available Handheld Retinal Cameras Effectively Screen Diabetic Retinopathy?

2016 ◽  
Vol 11 (1) ◽  
pp. 135-137 ◽  
Author(s):  
Jorge Cuadros ◽  
George Bresnick
Keyword(s):  
Clinical Trials ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Low Cost ◽  
Clinical Results ◽  
Diabetic Retinopathy Screening ◽  
The United Kingdom ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
Retinopathy Screening

Organizations that care for people with diabetes have increasingly adopted telemedicine-based diabetic retinopathy screening (TMDRS) as a way to increase adherence to recommended retinal exams. Recently, handheld retinal cameras have emerged as a low-cost, lightweight alternative to traditional bulky tabletop retinal cameras. Few published clinical trials have been performed on handheld retinal cameras. Peer-reviewed articles about commercially available handheld retinal cameras have concluded that they are a usable alternative for TMDRS, however, the clinical results presented in these articles do not meet criteria published by the United Kingdom Diabetic Eye Screening Programme and the American Academy of Ophthalmology. The future will likely remedy the shortcomings of currently available handheld retinal cameras, and will create more opportunities for preventing diabetic blindness.

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