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Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration during Diabetic Retinopathy Screening.
Ophthalmology. 2015 Nov; 122(11):2278-85.O

Abstract

PURPOSE

To determine whether screening for age-related macular degeneration (AMD) during a diabetic retinopathy (DR) screening program would be cost effective in Hong Kong.

DESIGN

We compared and evaluated the impacts of screening, grading, and vitamin treatment for intermediate AMD compared with no screening using a Markov model. It was based on the natural history of AMD in a cohort with a mean age of 62 years, followed up until 100 years of age or death.

PARTICIPANTS

Subjects attending a DR screening program were recruited.

METHOD

A cost-effectiveness analysis was undertaken from a public provider perspective. It included grading for AMD using the photographs obtained for DR screening and treatment with vitamin therapy for those with intermediate AMD. The measures of effectiveness were obtained largely from a local study, but the transition probabilities and utility values were from overseas data. Costs were all from local sources. The main assumptions and estimates were tested in sensitivity analyses.

MAIN OUTCOME MEASURES

The outcome was cost per quality-adjusted life year (QALY) gained. Both costs and benefits were discounted at 3%. All costs are reported in United States dollars ($).

RESULTS

The cost per QALY gained through screening for AMD and vitamin treatment for appropriate cases was $12,712 after discounting. This would be considered highly cost effective based on the World Health Organization's threshold of willingness to pay (WTP) for a QALY, that is, less than the annual per capita gross domestic product of $29,889. Because of uncertainty regarding the utility value for those with advanced AMD, we also tested an extreme, conservative value for utility under which screening remained cost effective. One-way sensitivity analyses revealed that, besides utility values, the cost per QALY was most sensitive to the progression rate from intermediate to advanced AMD. The cost-effectiveness acceptability curve showed a WTP for a QALY of $29,000 or more has a more than 86% probability of being cost effective compared with no screening.

CONCLUSIONS

Our analysis demonstrated that AMD screening carried out simultaneously with DR screening for patients with diabetes would be cost effective in a Hong Kong public healthcare setting.

Authors+Show Affiliations

School of Public Health, The University of Hong Kong, Hong Kong, China.Department of Ophthalmology, The University of Hong Kong, Hong Kong, China. Electronic address: gangwani@hku.hk.School of Public Health, The University of Hong Kong, Hong Kong, China.School of Public Health, The University of Hong Kong, Hong Kong, China.Department of Ophthalmology, The University of Hong Kong, Hong Kong, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26315045

Citation

Chan, Christina K W., et al. "Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration During Diabetic Retinopathy Screening." Ophthalmology, vol. 122, no. 11, 2015, pp. 2278-85.
Chan CK, Gangwani RA, McGhee SM, et al. Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration during Diabetic Retinopathy Screening. Ophthalmology. 2015;122(11):2278-85.
Chan, C. K., Gangwani, R. A., McGhee, S. M., Lian, J., & Wong, D. S. (2015). Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration during Diabetic Retinopathy Screening. Ophthalmology, 122(11), 2278-85. https://doi.org/10.1016/j.ophtha.2015.06.050
Chan CK, et al. Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration During Diabetic Retinopathy Screening. Ophthalmology. 2015;122(11):2278-85. PubMed PMID: 26315045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-Effectiveness of Screening for Intermediate Age-Related Macular Degeneration during Diabetic Retinopathy Screening. AU - Chan,Christina K W, AU - Gangwani,Rita A, AU - McGhee,Sarah M, AU - Lian,JinXiao, AU - Wong,David S H, Y1 - 2015/08/24/ PY - 2014/05/22/received PY - 2015/06/30/revised PY - 2015/06/30/accepted PY - 2015/8/29/entrez PY - 2015/9/1/pubmed PY - 2016/2/5/medline SP - 2278 EP - 85 JF - Ophthalmology JO - Ophthalmology VL - 122 IS - 11 N2 - PURPOSE: To determine whether screening for age-related macular degeneration (AMD) during a diabetic retinopathy (DR) screening program would be cost effective in Hong Kong. DESIGN: We compared and evaluated the impacts of screening, grading, and vitamin treatment for intermediate AMD compared with no screening using a Markov model. It was based on the natural history of AMD in a cohort with a mean age of 62 years, followed up until 100 years of age or death. PARTICIPANTS: Subjects attending a DR screening program were recruited. METHOD: A cost-effectiveness analysis was undertaken from a public provider perspective. It included grading for AMD using the photographs obtained for DR screening and treatment with vitamin therapy for those with intermediate AMD. The measures of effectiveness were obtained largely from a local study, but the transition probabilities and utility values were from overseas data. Costs were all from local sources. The main assumptions and estimates were tested in sensitivity analyses. MAIN OUTCOME MEASURES: The outcome was cost per quality-adjusted life year (QALY) gained. Both costs and benefits were discounted at 3%. All costs are reported in United States dollars ($). RESULTS: The cost per QALY gained through screening for AMD and vitamin treatment for appropriate cases was $12,712 after discounting. This would be considered highly cost effective based on the World Health Organization's threshold of willingness to pay (WTP) for a QALY, that is, less than the annual per capita gross domestic product of $29,889. Because of uncertainty regarding the utility value for those with advanced AMD, we also tested an extreme, conservative value for utility under which screening remained cost effective. One-way sensitivity analyses revealed that, besides utility values, the cost per QALY was most sensitive to the progression rate from intermediate to advanced AMD. The cost-effectiveness acceptability curve showed a WTP for a QALY of $29,000 or more has a more than 86% probability of being cost effective compared with no screening. CONCLUSIONS: Our analysis demonstrated that AMD screening carried out simultaneously with DR screening for patients with diabetes would be cost effective in a Hong Kong public healthcare setting. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/26315045/Cost_Effectiveness_of_Screening_for_Intermediate_Age_Related_Macular_Degeneration_during_Diabetic_Retinopathy_Screening_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(15)00664-8 DB - PRIME DP - Unbound Medicine ER -