TY - JOUR
T1 - Improving the cost-effectiveness of photographic screening for diabetic macular oedema
T2 - a prospective, multi-centre, UK study
AU - Prescott, Gordon
AU - Sharp, Peter
AU - Goatman, Keith
AU - Scotland, Graham
AU - Fleming, Alan
AU - Philip, Sam
AU - Staff, Roger
AU - Santiago, Cynthia
AU - Borooah, Shyamanga
AU - Broadbent, Deborah
AU - Chong, Victor
AU - Dodson, Paul
AU - Harding, Simon
AU - Leese, Graham
AU - Megaw, Roly
AU - Styles, Caroline
AU - Swa, Ken
AU - Wharton, Helen
AU - Olson, John
N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
PY - 2014/12/31
Y1 - 2014/12/31
N2 - Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.
AB - Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.
UR - http://www.scopus.com/inward/record.url?scp=84905112725&partnerID=8YFLogxK
UR - https://bjo.bmj.com/content/98/8/1042
U2 - 10.1136/bjophthalmol-2013-304338
DO - 10.1136/bjophthalmol-2013-304338
M3 - Article
C2 - 24682180
AN - SCOPUS:84905112725
SN - 0007-1161
VL - 98
SP - 1042
EP - 1049
JO - British Journal of Ophthalmology
JF - British Journal of Ophthalmology
IS - 8
ER -