Abstract
Purpose :
Diabetic macular edema (DME) has emerged as the foremost cause of vision impairment among individuals with diabetic mellitus (DM). Early detection is paramount, yet the prevailing screening method, relying on labor-intensive fundus photography (FP), results in excessive resource utilization, frequent unwarranted referrals, and overlooked diagnoses. In this context, self-imaging optical coherence tomography (SI-OCT) emerges as a transformative technology offering fully automated, three-dimensional macular imaging. Whether it could enhance the accuracy and cost-effectiveness of DME screening remains unknown.
Methods :
We conducted an observational measurement comparison study within a DM population residing. A cohort of 1646 participants underwent comprehensive assessments, including visual acuity testing, FP, and SI-OCT examinations. Our investigation compared the screening performance of four strategies: the conventional FP-based method, SI-OCT alone, a combination strategy encompassing both FP and SI-OCT, and manual OCT in isolation. Additionally, we undertook a comprehensive cost-effectiveness analysis utilizing Markov models, extending our evaluation over a ten-year horizon, from the perspective of the healthcare system.
Results :
The SI-OCT alone strategy and the combination strategy demonstrated notably superior sensitivity (87.69% and 96.92%, respectively) in detecting DME when compared to the traditional FP-based approach (61.53%). Furthermore, the SI-OCT strategy exhibited enhanced specificity (98.29% vs. 92.47%) for DME detection, surpassing the performance of FP-based screening. Importantly, owing to its lower estimated costs and greater gains in quality-adjusted life years, the SI-OCT strategy decisively outperformed the traditional FP-based method, yielding a negative incremental cost-effectiveness ratio. Our results, characterized by resilience to extensive sensitivity analyses, underscore the compelling rationale for adopting SI-OCT-based screening strategies. SI-OCT stands as the dominant choice in 96.12% of simulations conducted, aligning with current willingness-to-pay thresholds.
Conclusions :
Self-imaging OCT emerges as a highly promising tool for DME screening in underdeveloped regions, offering substantial enhancements in sensitivity, specificity, and, most notably, cost-effectiveness.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.