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

G. Scotland (Corresponding Author), P. McKeigue, S. Philip, G. P. Leese, J. A. Olson, H. C. Looker, H. M. Colhoun, M. Javanbakht

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Abstract

Aims:
To assess the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland.
Methods:
A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (two-year) screening for groups identified as low risk was then assessed over a 30 year time horizon.
Results:
Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per QALY gained for annual versus biennial screening ranged from ~£74,000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to ~£232,000 per QALY gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; ~£22,000 to £85,000 per QALY gained respectively.
Conclusions:
Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.
Original languageEnglish
Pages (from-to)886-895
Number of pages10
JournalDiabetic Medicine
Volume33
Issue number7
Early online date11 May 2016
DOIs
Publication statusPublished - Jul 2016

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Scotland
Diabetic Retinopathy
Cost-Benefit Analysis
Quality-Adjusted Life Years
Type 1 Diabetes Mellitus
Visual Acuity
Costs and Cost Analysis
Uncertainty
Quality of Life
Population

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Modelling the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. / Scotland, G. (Corresponding Author); McKeigue, P.; Philip, S.; Leese, G. P. ; Olson, J. A.; Looker, H. C.; Colhoun, H. M.; Javanbakht, M.

In: Diabetic Medicine, Vol. 33, No. 7, 07.2016, p. 886-895.

Research output: Contribution to journalArticle

Scotland, G. ; McKeigue, P. ; Philip, S. ; Leese, G. P. ; Olson, J. A. ; Looker, H. C. ; Colhoun, H. M. ; Javanbakht, M. / Modelling the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. In: Diabetic Medicine. 2016 ; Vol. 33, No. 7. pp. 886-895.
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title = "Modelling the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland",
abstract = "Aims:To assess the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. Methods:A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (two-year) screening for groups identified as low risk was then assessed over a 30 year time horizon.Results:Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per QALY gained for annual versus biennial screening ranged from ~£74,000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to ~£232,000 per QALY gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; ~£22,000 to £85,000 per QALY gained respectively.Conclusions:Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.",
author = "G. Scotland and P. McKeigue and S. Philip and Leese, {G. P.} and Olson, {J. A.} and Looker, {H. C.} and Colhoun, {H. M.} and M. Javanbakht",
note = "Funding sources: The study was funded by a research grant from the Chief Scientist’s Office of the Scottish Government Health and Social Care Directorates (CZH/4/971). The funder played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions. The views expressed herein are those of the authors and do not necessarily reflect those of the funder. Acknowledgements: The authors would like to thank Drs Vijay Hegde (NHS Grampian), William Wykes, Sonia Zachariah (NHS Glasgow), Karin Madill (NHS Lothian), Caroline Styles (NHS Fife), Mohan Varikkara (NHS Ayrshire and Arran), and Brian Power (NHS Dumfries and Galloway) for providing information on their current clinical practice for dealing with referrals from the diabetic retinopathy screening programme in Scotland.",
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T1 - Modelling the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland

AU - Scotland, G.

AU - McKeigue, P.

AU - Philip, S.

AU - Leese, G. P.

AU - Olson, J. A.

AU - Looker, H. C.

AU - Colhoun, H. M.

AU - Javanbakht, M.

N1 - Funding sources: The study was funded by a research grant from the Chief Scientist’s Office of the Scottish Government Health and Social Care Directorates (CZH/4/971). The funder played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions. The views expressed herein are those of the authors and do not necessarily reflect those of the funder. Acknowledgements: The authors would like to thank Drs Vijay Hegde (NHS Grampian), William Wykes, Sonia Zachariah (NHS Glasgow), Karin Madill (NHS Lothian), Caroline Styles (NHS Fife), Mohan Varikkara (NHS Ayrshire and Arran), and Brian Power (NHS Dumfries and Galloway) for providing information on their current clinical practice for dealing with referrals from the diabetic retinopathy screening programme in Scotland.

PY - 2016/7

Y1 - 2016/7

N2 - Aims:To assess the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. Methods:A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (two-year) screening for groups identified as low risk was then assessed over a 30 year time horizon.Results:Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per QALY gained for annual versus biennial screening ranged from ~£74,000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to ~£232,000 per QALY gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; ~£22,000 to £85,000 per QALY gained respectively.Conclusions:Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.

AB - Aims:To assess the cost-effectiveness of adopting risk stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. Methods:A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (two-year) screening for groups identified as low risk was then assessed over a 30 year time horizon.Results:Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per QALY gained for annual versus biennial screening ranged from ~£74,000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to ~£232,000 per QALY gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; ~£22,000 to £85,000 per QALY gained respectively.Conclusions:Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes.

U2 - 10.1111/dme.13129

DO - 10.1111/dme.13129

M3 - Article

VL - 33

SP - 886

EP - 895

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

IS - 7

ER -