Will the use of optical coherence tomography enhance cost-effectiveness of diabetic retinopathy screening?

Session Details

Session Title: Free Paper Session 11: Vascular Diseases & Diabetic Retinopathy III

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 11:18

Venue: Room 114

First Author: : I.Wong HONG KONG

Co Author(s): :    R. Wong                             

Abstract Details

Purpose:

1. To compare the sensitivity indexes of the current fundus photo-based screening strategy (Strategy A) in detecting diabetic macular edema (DME) with three new screening strategies involving: a) removing retinal haemhorrage on fundus photo as a surrogate marker for maculopathy (Strategy B), or b) adding best-corrected visual acuity (BCVA) measurement and performing optical coherence tomography (OCT) scans on selected cases on top of the current protocol (Strategy C), or c) adding an OCT scans for all subjects in addition to the current protocol (Strategy D). 2. To develop a cost-effectiveness model to identify the most cost-effective strategy.

Setting:

Region-wide diabetic retinopathy screening program at the University of Hong Kong, with a catchment population of 500,000.

Methods:

In this cross-sectional, observational study, subjects were screened according to the protocol as set out in Strategy A, i.e. the current fundus-photo based protocol. Best-corrected-visual-acuity (BCVA) and OCT scans of the macula were performed on all subjects. Each subject was simulated to undergo each of the 4 strategies. Should maculopathy be detected according to the specific criteria in a particular strategy, it would be recorded and assumed to be referred. Costs of the screening, ophthalmologist consultation, and treatment for up to 12 months were estimated. Quality-adjusted-life-years (QALYs) gained was calculated for each specific strategy. Incremental cost-effective ratios (ICERs) were calculated with Strategy A as the benchmark. The local gross domestic product per capita and US dollars $50,000/QALY gained were used as references to determine cost-effectiveness.

Results:

All strategies were found to be ‘very cost-effective’. In particular, Strategy D was found to be most cost-effective among the four. Although it cost the most, it enabled the most QALY gained, hence the cost per QALY gained was the lowest.

Conclusions:

Incorporating OCT scans of the macula for all on top of the current protocol (i.e. Strategy D) appeared to be more cost-effective than the current protocol. This should be considered in future planning.

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