A personalised screening strategy for diabetic retinopathy: a cost-effectiveness perspective

被引：10

作者：

Emamipour, Sajad ^{[1
]}

van der Heijden, Amber A. W. A. ^{[2
]}

Nijpels, Giel ^{[2
]}

Elders, Petra ^{[2
]}

Beulens, Joline W. J. ^{[2
]}

Postma, Maarten J. ^{[3
,4
,5
]}

van Boven, Job F. M. ^{[1
]}

Feenstra, Talitha L. ^{[4
,6
,7
]}

机构：

[1] Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, NL-9700 RB Groningen, Netherlands

[2] Univ Amsterdam, Dept Gen Practice & Elderly Care Med, Locat VU, Med Ctr, Amsterdam, Netherlands

[3] Univ Groningen, Univ Med Ctr Groningen, Dept Hlth Sci, Groningen, Netherlands

[4] Univ Groningen, Fac Sci & Engn, Groningen Res Inst Pharm, Groningen, Netherlands

[5] Univ Groningen, Fac Econ & Business, Dept Econ Econometr & Finance, Groningen, Netherlands

[6] Univ Groningen, Univ Med Ctr Groningen, Dept Epidemiol, Groningen, Netherlands

[7] Natl Inst Publ Hlth & Environm RIVM, Bilthoven, Netherlands

来源：

DIABETOLOGIA | 2020年 / 63卷 / 11期

基金：

欧盟地平线“2020”;

关键词：

Cost-effectiveness; Diabetic retinopathy; Risk assessment; Screening intervals; MAJOR RISK-FACTORS; GLOBAL PREVALENCE; INTERVAL; OPTIMIZATION; FREQUENCY; PROGRAM; MODEL;

D O I：

10.1007/s00125-020-05239-9

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 euro11.4 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 (euro1.8 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 euro11.4 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.

引用

页码：2452 / 2461

页数：10