A personalised screening strategy for diabetic retinopathy: a cost-effectiveness perspective
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ARTICLE
A personalised screening strategy for diabetic retinopathy: a cost-effectiveness perspective Sajad Emamipour 1 & Amber A. W. A. van der Heijden 2 & Giel Nijpels 2 & Petra Elders 2 & Joline W. J. Beulens 2 & Maarten J. Postma 3,4,5 & Job F. M. van Boven 1 & Talitha L. Feenstra 4,6,7 Received: 11 December 2019 / Accepted: 10 June 2020 # The Author(s) 2020
Abstract Aims/hypothesis In this study we examined the cost-effectiveness of three different screening strategies for diabetic retinopathy: using a personalised adaptive model, annual screening (fixed intervals), and the current Dutch guideline (stratified based on previous retinopathy grade). Methods For each individual, optimal diabetic retinopathy screening intervals were determined, using a validated risk prediction model. Observational data (1998–2017) from the Hoorn Diabetes Care System cohort of people with type 2 diabetes were used (n = 5514). The missing values of retinopathy grades were imputed using two scenarios of slow and fast sight-threatening retinopathy (STR) progression. By comparing the model-based screening intervals to observed time to develop STR, the number of delayed STR diagnoses was determined. Costs were calculated using the healthcare perspective and the societal perspective. Finally, outcomes and costs were compared for the different screening strategies. Results For the fast STR progression scenario, personalised screening resulted in 11.6% more delayed STR diagnoses and €11.4 less costs per patient compared to annual screening from a healthcare perspective. The personalised screening model performed better in terms of timely diagnosis of STR (8.8% less delayed STR diagnosis) but it was slightly more expensive (€1.8 per patient from a healthcare perspective) than the Dutch guideline strategy. Conclusions/interpretation The personalised diabetic retinopathy screening model is more cost-effective than the Dutch guideline screening strategy. Although the personalised screening strategy was less effective, in terms of timely diagnosis of STR patients, than annual screening, the number of delayed STR diagnoses is low and the cost saving is considerable. With around one million people with type 2 diabetes in the Netherlands, implementing this personalised model could save €11.4 million per year compared with annual screening, at the cost of 658 delayed STR diagnoses with a maximum delayed time to diagnosis of 48 months. Keywords Cost-effectiveness . Diabetic retinopathy . Risk assessment . Screening intervals
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-020-05239-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users. * Sajad Emamipour [email protected]
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Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
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Depa
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