The cost-effectiveness of three screening alternatives for people with diabetes with no or early diabetic retinopathy.

Kleins Lab // Publications // Oct 01 2011

PubMed ID: 21492158

Author(s): Rein DB, Wittenborn JS, Zhang X, Allaire BA, Song MS, Klein R, Saaddine JB; Vision Cost-Effectiveness Study Group. The cost-effectiveness of three screening alternatives for people with diabetes with no or early diabetic retinopathy. Health Serv Res. 2011 Oct;46(5):1534-61. doi: 10.1111/j.1475-6773.2011.01263.x. Epub 2011 Apr 14. Review. PMID 21492158

Journal: Health Services Research, Volume 46, Issue 5, Oct 2011

OBJECTIVE To determine whether biennial eye evaluation or telemedicine screening are cost-effective alternatives to current recommendations for the estimated 10 million people aged 30-84 with diabetes but no or minimal diabetic retinopathy.

DATA SOURCES United Kingdom Prospective Diabetes Study, National Health and Nutrition Examination Survey, American Academy of Ophthalmology Preferred Practice Patterns, Medicare Payment Schedule.

STUDY DESIGN Cost-effectiveness Monte Carlo simulation.

DATA COLLECTION/EXTRACTION METHODS Literature review, analysis of existing surveys.

PRINCIPAL FINDINGS Biennial eye evaluation was the most cost-effective treatment option when the ability to detect other eye conditions was included in the model. Telemedicine was most cost-effective when other eye conditions were not considered or when telemedicine was assumed to detect refractive error. The current annual eye evaluation recommendation was costly compared with either treatment alternative. Self-referral was most cost-effective up to a willingness to pay (WTP) of U.S.$37,600, with either biennial or annual evaluation most cost-effective at higher WTP levels.

CONCLUSIONS Annual eye evaluations are costly and add little benefit compared with either plausible alternative. More research on the ability of telemedicine to detect other eye conditions is needed to determine whether it is more cost-effective than biennial eye evaluation.

© Health Research and Educational Trust.