RT Journal Article
SR Electronic
T1 Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 1042
OP 1049
DO 10.1136/bjophthalmol-2013-304338
VO 98
IS 8
A1 Gordon Prescott
A1 Peter Sharp
A1 Keith Goatman
A1 Graham Scotland
A1 Alan Fleming
A1 Sam Philip
A1 Roger Staff
A1 Cynthia Santiago
A1 Shyamanga Borooah
A1 Deborah Broadbent
A1 Victor Chong
A1 Paul Dodson
A1 Simon Harding
A1 Graham Leese
A1 Roly Megaw
A1 Caroline Styles
A1 Ken Swa
A1 Helen Wharton
A1 John Olson
YR 2014
UL http://bjo.bmj.com/content/98/8/1042.abstract
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.