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Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening

Becky Thomas, Thomas G. Winfield, Matthew Prettyjohns, Frank D. Dunstan, Ivy Cheung, Pippa Anderson, Rajesh Peter, Steve Luzio Orcid Logo, David Owens Orcid Logo, Rajesh Peter

The European Journal of Health Economics

Swansea University Authors: Becky Thomas, Ivy Cheung, Pippa Anderson, Steve Luzio Orcid Logo, David Owens Orcid Logo, Rajesh Peter

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DOI (Published version): 10.1007/s10198-020-01191-y

Abstract

Objective: Examine the health and economic impact of extending screening intervals in people with Type 2 diabetes (T2DM) and Type 1 diabetes (T1DM) without diabetes related retinopathy (DR).Setting: Diabetic Eye Screening Wales (DESW)Study design: Retrospective observational study with cost utility...

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Published in: The European Journal of Health Economics
ISSN: 1618-7598 1618-7601
Published: Springer Science and Business Media LLC 2020
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URI: https://cronfa.swan.ac.uk/Record/cronfa54012
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Inputs: Anonymised data from DESW were linked to primary care data for people with two prior screening events with no DR. Transition probabilities for progression to DR were estimated based on a subset of 26,812 and 1,232 people with T2DM and T1DM, respectively. DCER above &#xA3;20,000 per QALY was considered cost-effective.Results: The base case analysis DCER results of &#xA3;71,243 and &#xA3;23,446 per QALY for T2DM and T1DM respectively at a 3.5% discount rate and &#xA3;56,822 and &#xA3;14,221 respectively when discounted at 1.5% . Diabetes management represented by the mean HbA1c was 7.5% for those with T2DM and 8.7% for T1DM.Sensitivity analysis: Extending screening to biennial based on HbA1c, being the strongest predictor of progression of DR, at three levels of HbA1c 6.5%, 8.0% and 9.5% lost one QALY saving the NHS &#xA3;106,075; &#xA3;58,653 and &#xA3;31,626 respectively for T2DM and &#xA3;94,696, &#xA3;37,646 and &#xA3;11,089 respectively for T1DM. In addition, extending screening to biennial based on duration of diabetes &gt;6 years for T2DM per QALY lost, saving the NHS &#xA3;54,106 and for 6-12 and &gt;12 years for T1DM saving &#xA3;83,856, &#xA3;23,446 and &#xA3;13,340 respectively. Conclusions: Base case and sensitivity analyses indicates biennial screening to be cost-effective for T2DM irrespective of HbA1c and duration of diabetes. However, the uncertainty around the DCER indicates that annual screening should be maintained for those with T1DM especially when the HbA1c exceeds 80 mmol/mol (9.5%) and duration of diabetes is greater than 12 years.</abstract><type>Journal Article</type><journal>The European Journal of Health Economics</journal><publisher>Springer Science and Business Media LLC</publisher><issnPrint>1618-7598</issnPrint><issnElectronic>1618-7601</issnElectronic><keywords>Diabetic retinopathy; Screening; Economic impact; Cost-utility analysis</keywords><publishedDay>8</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2020</publishedYear><publishedDate>2020-05-08</publishedDate><doi>10.1007/s10198-020-01191-y</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2020-05-28T10:31:46.5532309</lastEdited><Created>2020-04-21T17:15:23.1882956</Created><authors><author><firstname>Becky</firstname><surname>Thomas</surname><orcid/><order>1</order></author><author><firstname>Thomas G.</firstname><surname>Winfield</surname><order>2</order></author><author><firstname>Matthew</firstname><surname>Prettyjohns</surname><order>3</order></author><author><firstname>Frank D.</firstname><surname>Dunstan</surname><order>4</order></author><author><firstname>Ivy</firstname><surname>Cheung</surname><order>5</order></author><author><firstname>Pippa</firstname><surname>Anderson</surname><order>6</order></author><author><firstname>Rajesh</firstname><surname>Peter</surname><order>7</order></author><author><firstname>Steve</firstname><surname>Luzio</surname><orcid>0000-0002-7206-6530</orcid><order>8</order></author><author><firstname>David</firstname><surname>Owens</surname><orcid>0000-0003-1002-1238</orcid><order>9</order></author><author><firstname>Rajesh</firstname><surname>Peter</surname><order>10</order></author></authors><documents><document><filename>54012__17263__27ea3ad1aa1746148808270730cd5986.pdf</filename><originalFilename>54012VOR.pdf</originalFilename><uploaded>2020-05-15T18:31:58.3990082</uploaded><type>Output</type><contentLength>845448</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Released under the terms of a Creative Commons Attribution 4.0 International License (CC-BY).</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2020-05-28T10:31:46.5532309 v2 54012 2020-04-21 Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening e83b45ec71428bd748ce201048f43d6a Becky Thomas Becky Thomas true false a9142ffd398f89eff40ada503e315639 Ivy Cheung Ivy Cheung true false 128cdedfba6e5e6374fdc85d5c78c428 Pippa Anderson Pippa Anderson true false 01491e1cd582746a654fad9addf0de16 0000-0002-7206-6530 Steve Luzio Steve Luzio true false 2fd4b7c3f82c6d3bd546eff61ff944e9 0000-0003-1002-1238 David Owens David Owens true false 7feee6f5cccd81493190ce281acebb9c Rajesh Peter Rajesh Peter true false 2020-04-21 HDAT Objective: Examine the health and economic impact of extending screening intervals in people with Type 2 diabetes (T2DM) and Type 1 diabetes (T1DM) without diabetes related retinopathy (DR).Setting: Diabetic Eye Screening Wales (DESW)Study design: Retrospective observational study with cost utility analysis (CUA) and Decremental Cost Effectiveness Ratios (DCER) study.Intervention: Biennial screening versus usual care (annual screening). Inputs: Anonymised data from DESW were linked to primary care data for people with two prior screening events with no DR. Transition probabilities for progression to DR were estimated based on a subset of 26,812 and 1,232 people with T2DM and T1DM, respectively. DCER above £20,000 per QALY was considered cost-effective.Results: The base case analysis DCER results of £71,243 and £23,446 per QALY for T2DM and T1DM respectively at a 3.5% discount rate and £56,822 and £14,221 respectively when discounted at 1.5% . Diabetes management represented by the mean HbA1c was 7.5% for those with T2DM and 8.7% for T1DM.Sensitivity analysis: Extending screening to biennial based on HbA1c, being the strongest predictor of progression of DR, at three levels of HbA1c 6.5%, 8.0% and 9.5% lost one QALY saving the NHS £106,075; £58,653 and £31,626 respectively for T2DM and £94,696, £37,646 and £11,089 respectively for T1DM. In addition, extending screening to biennial based on duration of diabetes >6 years for T2DM per QALY lost, saving the NHS £54,106 and for 6-12 and >12 years for T1DM saving £83,856, £23,446 and £13,340 respectively. Conclusions: Base case and sensitivity analyses indicates biennial screening to be cost-effective for T2DM irrespective of HbA1c and duration of diabetes. However, the uncertainty around the DCER indicates that annual screening should be maintained for those with T1DM especially when the HbA1c exceeds 80 mmol/mol (9.5%) and duration of diabetes is greater than 12 years. Journal Article The European Journal of Health Economics Springer Science and Business Media LLC 1618-7598 1618-7601 Diabetic retinopathy; Screening; Economic impact; Cost-utility analysis 8 5 2020 2020-05-08 10.1007/s10198-020-01191-y COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 2020-05-28T10:31:46.5532309 2020-04-21T17:15:23.1882956 Becky Thomas 1 Thomas G. Winfield 2 Matthew Prettyjohns 3 Frank D. Dunstan 4 Ivy Cheung 5 Pippa Anderson 6 Rajesh Peter 7 Steve Luzio 0000-0002-7206-6530 8 David Owens 0000-0003-1002-1238 9 Rajesh Peter 10 54012__17263__27ea3ad1aa1746148808270730cd5986.pdf 54012VOR.pdf 2020-05-15T18:31:58.3990082 Output 845448 application/pdf Version of Record true Released under the terms of a Creative Commons Attribution 4.0 International License (CC-BY). true eng http://creativecommons.org/licenses/by/4.0/
title Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
spellingShingle Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
Becky Thomas
Ivy Cheung
Pippa Anderson
Steve Luzio
David Owens
Rajesh Peter
title_short Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
title_full Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
title_fullStr Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
title_full_unstemmed Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
title_sort Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening
author_id_str_mv e83b45ec71428bd748ce201048f43d6a
a9142ffd398f89eff40ada503e315639
128cdedfba6e5e6374fdc85d5c78c428
01491e1cd582746a654fad9addf0de16
2fd4b7c3f82c6d3bd546eff61ff944e9
7feee6f5cccd81493190ce281acebb9c
author_id_fullname_str_mv e83b45ec71428bd748ce201048f43d6a_***_Becky Thomas
a9142ffd398f89eff40ada503e315639_***_Ivy Cheung
128cdedfba6e5e6374fdc85d5c78c428_***_Pippa Anderson
01491e1cd582746a654fad9addf0de16_***_Steve Luzio
2fd4b7c3f82c6d3bd546eff61ff944e9_***_David Owens
7feee6f5cccd81493190ce281acebb9c_***_Rajesh Peter
author Becky Thomas
Ivy Cheung
Pippa Anderson
Steve Luzio
David Owens
Rajesh Peter
author2 Becky Thomas
Thomas G. Winfield
Matthew Prettyjohns
Frank D. Dunstan
Ivy Cheung
Pippa Anderson
Rajesh Peter
Steve Luzio
David Owens
Rajesh Peter
format Journal article
container_title The European Journal of Health Economics
publishDate 2020
institution Swansea University
issn 1618-7598
1618-7601
doi_str_mv 10.1007/s10198-020-01191-y
publisher Springer Science and Business Media LLC
document_store_str 1
active_str 0
description Objective: Examine the health and economic impact of extending screening intervals in people with Type 2 diabetes (T2DM) and Type 1 diabetes (T1DM) without diabetes related retinopathy (DR).Setting: Diabetic Eye Screening Wales (DESW)Study design: Retrospective observational study with cost utility analysis (CUA) and Decremental Cost Effectiveness Ratios (DCER) study.Intervention: Biennial screening versus usual care (annual screening). Inputs: Anonymised data from DESW were linked to primary care data for people with two prior screening events with no DR. Transition probabilities for progression to DR were estimated based on a subset of 26,812 and 1,232 people with T2DM and T1DM, respectively. DCER above £20,000 per QALY was considered cost-effective.Results: The base case analysis DCER results of £71,243 and £23,446 per QALY for T2DM and T1DM respectively at a 3.5% discount rate and £56,822 and £14,221 respectively when discounted at 1.5% . Diabetes management represented by the mean HbA1c was 7.5% for those with T2DM and 8.7% for T1DM.Sensitivity analysis: Extending screening to biennial based on HbA1c, being the strongest predictor of progression of DR, at three levels of HbA1c 6.5%, 8.0% and 9.5% lost one QALY saving the NHS £106,075; £58,653 and £31,626 respectively for T2DM and £94,696, £37,646 and £11,089 respectively for T1DM. In addition, extending screening to biennial based on duration of diabetes >6 years for T2DM per QALY lost, saving the NHS £54,106 and for 6-12 and >12 years for T1DM saving £83,856, £23,446 and £13,340 respectively. Conclusions: Base case and sensitivity analyses indicates biennial screening to be cost-effective for T2DM irrespective of HbA1c and duration of diabetes. However, the uncertainty around the DCER indicates that annual screening should be maintained for those with T1DM especially when the HbA1c exceeds 80 mmol/mol (9.5%) and duration of diabetes is greater than 12 years.
published_date 2020-05-08T04:07:18Z
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score 11.01628

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