July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
The costs of screening for sight-threatening diabetic retinopathy
Author Affiliations & Notes
  • Simon P Harding
    Eye and Vision Science, University of Liverpool, Liverpool, ENGLAND, United Kingdom
    St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
  • Christopher J Sampson
    Health Economics, University of Nottingham, United Kingdom
  • Ticiana M Criddle
    St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
    Eye and Vision Science, University of Liverpool, Liverpool, ENGLAND, United Kingdom
  • Deborah M Broadbent
    St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
    Eye and Vision Science, University of Liverpool, Liverpool, ENGLAND, United Kingdom
  • Marilyn James
    Health Economics, University of Nottingham, United Kingdom
  • Footnotes
    Commercial Relationships   Simon Harding, None; Christopher Sampson, None; Ticiana Criddle, None; Deborah Broadbent, None; Marilyn James, None
  • Footnotes
    Support  NIHR Programme Grant for Applied Research RP-PG-1210-12016
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4802. doi:https://doi.org/
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    • Get Citation

      Simon P Harding, Christopher J Sampson, Ticiana M Criddle, Deborah M Broadbent, Marilyn James; The costs of screening for sight-threatening diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4802. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Data on costs of screening for diabetic retinopathy are very limited. We estimated the average costs of annual screening for sight threatening diabetic retinopathy in an established population based photography programme including disaggregated costs of grading, image acquisition and non-attendance, and costs to society.

Methods : Mixed microcosting and observational health economics analysis of data collected in routine screening in the Liverpool Diabetes Eye Screening Programme, established in 1991. Analyses comprised time studies (7 screening sites), resource use: associated staff costs (admin/management, screening, grading), capital (10 year write down) and consumables, and patient and attender costs (self completed questionnaire with assistance if required). Unit costs were directly identified or derived from Unit Costs of Health and Social Care 2017 where necessary. Cost estimates were summed to estimate an average cost per screening attendance from the payer's perspective for: the commissioner, the patient, society.

Results : Average commissioner cost (2016-17) for 16,736 screen events attended was £33.61. Ingredient analysis showed cost estimates per attended appointment invitation of £26.07 (administration/management £11.24, image acquisition £8.12, grading £6.71) and for appointments not attended of £12.05 (non-attendance rate 36.9%). Correcting for non-attendance rate this gave a bottom-up cost of £30.52 per screen event attended.
868 patient resource use questionnaires were completed. Costs per patient where incurred were: personal transport - £2.36 car, £6.30 public; productivity loss - £26.08 (33.5% in employment), £23.74 for assistant. Mean overall costs per attendance were: personal travel £2.53, productivity loss £6.09, total societal cost £8.62.

Conclusions : Ingredient costs appear to be similar to the commissioned cost tariff. To address widespread variation in commissioning all aspects of the pathway should be identified transparently. Nonattendance is common, adding around 15% to the programme costs. Moderate savings (10-15%) per case could be achieved through introduction of automated grading. Societal costs are significant for certain groups and may hamper access.
This abstract presents independent research funded by the National Institute for Health Research UK (RP-PG-1210-12016). The views expressed are those of the authors, not those of the NHS, NIHR or Department of Health.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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