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Diana Beatriz Samson Bayani, Christelle Joy Reyes, Jennifer K Sun, Tunde Peto, Paolo Antonio Silva; Cost-effectiveness analysis of retinal imaging devices for diabetic retinopathy screening. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1093.
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To estimate and compare the cost-effectiveness of mydriatic and nonmydriatic imaging devices for consideration in a community-based program for diabetic retinopathy (DR) screening in the Philippines
A decision-analytic model was developed to simulate the costs and outcomes of each device [Aurora (AU), Smartscope (SS), RV700 (RV), InView (NV) with dilation and without dilation of the pupil. The key measures of effectiveness were determined by the devices’ operating characteristics including positive and negative predictive values and rate of ungradable images. These parameters, as well as the distribution of patients with varying severity levels of DR, were obtained from a validation study performed in Manila involving images from 177 eyes of 92 patients with diabetes. Associated costs of screening, referrals, panretinal laser photocoagulation for severe nonproliferative or proliferative DR, and corresponding cost of severe vision loss were estimated from the perspective of the patient. Health outcomes were reported as quality-adjusted life years (QALYs) based on utility values assigned to vision threatening DR and vision loss. The primary outcome measure is reported as cost in Philippine Peso (PhP) per QALY gained.
Analyses from the patient perspective show that all devices were dominated when the clinic-based screening test was used as comparator. When using the dominance approach, the NV and AU NM were strongly dominated, whereas the RV7 MD/NM, and SS MD were weakly dominated. The AU MD was most cost-effective with an incremental cost-effectiveness ratio (ICER) value of 71,207 PhP per QALY-gained versus the Smartscope MD. Results were most sensitive to changes in the cost of the comparator, rate of ungradable image and incidence of DR.
The use of Aurora and Smartscope with pupil dilation yield good value for money based on their validity, and the reported ICER value falls below the country-specific threshold of 150,000 PhP, which shows great potential for being cost-effective in a community-based DR screening program. A broader and more comprehensive analysis is warranted to account for societal costs when the devices are used in a larger-scale, relative to their individual and population-level benefits while considering other factors such as burden and treatment of disease, and health system capacity.
This is a 2021 ARVO Annual Meeting abstract.
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