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Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System.
Appl Health Econ Health Policy. 2020 02; 18(1):57-68.AH

Abstract

OBJECTIVE

To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System.

METHODS

A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters' uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018).

RESULTS

Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = -0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively.

CONCLUSION

Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

Authors+Show Affiliations

Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. a.jornadaben@vu.nl.Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.Faculty of Medicine, Universidade do Vale do Taquari, Lajeado, Brazil.Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil.Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.Ophthalmology Service, Hospital Moinhos de Vento, Porto Alegre, Brazil.Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31674001

Citation

Ben, Ângela J., et al. "Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies From the Perspective of the Brazilian Public Healthcare System." Applied Health Economics and Health Policy, vol. 18, no. 1, 2020, pp. 57-68.
Ben ÂJ, Neyeloff JL, de Souza CF, et al. Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System. Appl Health Econ Health Policy. 2020;18(1):57-68.
Ben, Â. J., Neyeloff, J. L., de Souza, C. F., Rosses, A. P. O., de Araujo, A. L., Szortika, A., Locatelli, F., de Carvalho, G., & Neumann, C. R. (2020). Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System. Applied Health Economics and Health Policy, 18(1), 57-68. https://doi.org/10.1007/s40258-019-00528-w
Ben ÂJ, et al. Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies From the Perspective of the Brazilian Public Healthcare System. Appl Health Econ Health Policy. 2020;18(1):57-68. PubMed PMID: 31674001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System. AU - Ben,Ângela J, AU - Neyeloff,Jeruza L, AU - de Souza,Camila F, AU - Rosses,Ana Paula O, AU - de Araujo,Aline L, AU - Szortika,Adriana, AU - Locatelli,Franciele, AU - de Carvalho,Gabriela, AU - Neumann,Cristina R, PY - 2019/11/2/pubmed PY - 2020/11/25/medline PY - 2019/11/2/entrez SP - 57 EP - 68 JF - Applied health economics and health policy JO - Appl Health Econ Health Policy VL - 18 IS - 1 N2 - OBJECTIVE: To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. METHODS: A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters' uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). RESULTS: Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = -0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. CONCLUSION: Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results. SN - 1179-1896 UR - https://www.unboundmedicine.com/medline/citation/31674001/Cost_utility_Analysis_of_Opportunistic_and_Systematic_Diabetic_Retinopathy_Screening_Strategies_from_the_Perspective_of_the_Brazilian_Public_Healthcare_System_ L2 - https://dx.doi.org/10.1007/s40258-019-00528-w DB - PRIME DP - Unbound Medicine ER -