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Ryo Kawasaki, Yoko Akune, Yoshimune Hiratsuka, Masakazu Yamada; Cost-utility analysis of screening program for diabetic retinopathy in Japan: a probabilistic Markov modeling study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1546.
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To evaluate the cost-effectiveness of screening program for diabetic retinopathy through the estimation of the incremental costs per Quality Adjusted Life Years (QALYs) gained using the best available clinical data and scenario in Japan.
We framed a Markov model with a probabilistic cohort analysis to calculate the incremental costs per QALY gained by implementing screening program for diabetic retinopathy in Japan. A one-year cycle length and a population size of 50000 with 50 years time horizon (age 40 to 90 years old) were applied. Best available clinical data were collected from publications and a model was designed with data on the course of diabetic retinopathy including diagnosis, treatment and visual outcomes. We then simulated uncertainties using univariate and probabilistic sensitivity analysis.
In base-case analysis, screening program for diabetic retinopathy was associated with incremental costs of Japanese yen (JPY) 5147 (US$64.6) and incremental effectiveness of 0.0054 QALYs per one screened person. The incremental cost effectiveness ratio (ICER) was JPY 944,981 (US$11,857) per QALY. Although reduction of low vision was modest (-5%), our simulation demonstrated significant reduction in persons with blindness (-16%) by screening for diabetic retinopathy. Our sensitivity analysis demonstrated that the most cost-effective screening program for diabetic retinopathy in Japan was to start screening at age of 53 years old with less than 5 years interval up to 84 years old.
Screening program for diabetic retinopathy in Japan is cost-effective even allowing for the uncertainty of the known variability that exists in estimates of costs, utilities, and complications rate. Further studies are warranted to determine the most effective screening strategy for preventing blindness from diabetic retinopathy.
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