Abstract
Purpose :
Utilization of digital technologies for cataract screening in primary care is a potential solution for the dilemma between growing aging population and unequal medical resources. We conducted an economic analysis of a digital technology-driven hierarchical screening (DHS) pattern implemented in China, including home-setting smartphone-based artificial intelligence (AI) screening, community-based AI diagnosis, and referral to tertiary hospitals.
Methods :
We developed decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different screening strategies (no screening, telescreening, AI screening and DHS) and considered different frequencies. A simulated cohort of 100,000 individuals from age 50 was built through a total of 30 1-year Markov cycles. Urban and rural settings were analyzed separately. The primary outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years (QALYs) and incremental costeffectiveness ratios (ICERs) using years of blindness avoided. One-way and probabilistic sensitivity analyses were used to assess the robustness of main outcomes.
Results :
DHS dominated no screening with ICURs of $-2407 (95% CI -2421 to -2394) and $-3006 (-3024 to -2989), and ICERs of $-3220 (-3237 to -3202) and $-3224 (-3242 to -3206) in urban and rural China, respectively. When compared to telescreening and AI screening, DHS had negative ICURs and ICERs, representing that it is dominating to traditional screening patterns with more benefits gained and less costs spent. Annual DHS emerged as the most economically effective strategy for cataract screening, with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided per 100,000 people screened compared with telescreening and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remained robust across all sensitivity analyses conducted.
Conclusions :
DHS is cost-effective in urban and rural China, and the annual strategy proved to be the most cost-effective option, providing a solid economic rationale for policymakers promoting public eye health in low- and middle-income countries.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.