Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System.
Journal
Applied health economics and health policy
ISSN: 1179-1896
Titre abrégé: Appl Health Econ Health Policy
Pays: New Zealand
ID NLM: 101150314
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
pubmed:
2
11
2019
medline:
25
11
2020
entrez:
2
11
2019
Statut:
ppublish
Résumé
To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. 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). 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. 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.
Identifiants
pubmed: 31674001
doi: 10.1007/s40258-019-00528-w
pii: 10.1007/s40258-019-00528-w
pmc: PMC6978298
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
57-68Subventions
Organisme : Ministério da Saúde
ID : 57/2013
Pays : International
Références
JAMA. 2000 Feb 16;283(7):889-96
pubmed: 10685713
Bull Pan Am Health Organ. 1993;27(4):337-49
pubmed: 8312957
Rev Bras Epidemiol. 2015 Dec;18 Suppl 2:17-32
pubmed: 27008600
Lancet Diabetes Endocrinol. 2019 Feb;7(2):140-149
pubmed: 30005958
Diabetol Metab Syndr. 2016 Sep 07;8(1):65
pubmed: 27610204
PLoS One. 2018 Aug 10;13(8):e0201723
pubmed: 30096201
Global Health. 2013 Dec 03;9:62
pubmed: 24299125
Diabetes Care. 1992 Jul;15(7):815-9
pubmed: 1516497
Ophthalmic Epidemiol. 2000 Dec;7(4):225-41
pubmed: 11262670
Expert Rev Clin Pharmacol. 2016;9(5):739-46
pubmed: 26873164
Diabetes Care. 2016 Sep;39(9):1643-9
pubmed: 27555623
Health Technol Assess. 2015 Sep;19(74):1-116
pubmed: 26384314
Fam Pract. 2017 Sep 1;34(5):546-551
pubmed: 28379410
Value Health Reg Issues. 2013 Dec;2(3):405-412
pubmed: 29702778
Arch Ophthalmol. 1994 Sep;112(9):1217-28
pubmed: 7619101
World J Diabetes. 2017 Apr 15;8(4):120-129
pubmed: 28465788
Clin Ophthalmol. 2016 Feb 10;10:285-95
pubmed: 26929592
J Korean Med Sci. 2015 Dec;30(12):1723-32
pubmed: 26713046
Bull World Health Organ. 2015 Feb 1;93(2):118-24
pubmed: 25883405
Cochrane Database Syst Rev. 2014 Nov 24;(11):CD011234
pubmed: 25420029
BMJ Glob Health. 2018 Jul 3;3(4):e000829
pubmed: 29997906
Lancet. 1998 Sep 12;352(9131):837-53
pubmed: 9742976
Diabetes Care. 2009 Dec;32(12):2307-13
pubmed: 19940227
Diabetol Metab Syndr. 2015 Oct 31;7:95
pubmed: 26523154
Diabet Med. 2010 Mar;27(3):249-56
pubmed: 20536486
BMJ. 2011 Apr 11;342:d1766
pubmed: 21482590
Drugs Context. 2018 Aug 13;7:212532
pubmed: 30181760
Eye Vis (Lond). 2015 Sep 30;2:17
pubmed: 26605370
Syst Rev. 2015 Feb 21;4:15
pubmed: 25875206
Br J Ophthalmol. 2015 Jun;99(6):823-31
pubmed: 25563767
Diabetes Res Clin Pract. 2017 Jun;128:40-50
pubmed: 28437734
Arch Endocrinol Metab. 2021 May 18;64(5):575-583
pubmed: 34033298
J Diabetes Sci Technol. 2015 Dec 29;10(2):301-7
pubmed: 26719134
Ophthalmic Epidemiol. 2015 Feb;22(1):4-12
pubmed: 25517603
Diabetes Res Clin Pract. 2010 Jan;87(1):15-9
pubmed: 19914728
Diabetes Care. 2012 Mar;35(3):556-64
pubmed: 22301125
Health Econ. 2004 May;13(5):405-15
pubmed: 15127421
Invest Ophthalmol Vis Sci. 2014 Sep 02;55(9):6108-15
pubmed: 25183764
Clin Cardiol. 2016 May;39(5):249-56
pubmed: 27080921
Value Health. 2003 Jan-Feb;6(1):9-17
pubmed: 12535234
Diabetes Care. 2004 May;27(5):1095-101
pubmed: 15111527
Diabetol Metab Syndr. 2015 Dec 21;7:116
pubmed: 26697120
Int J Technol Assess Health Care. 2017 Jan;33(2):251-260
pubmed: 28641592
Ophthalmology. 2013 Mar;120(3):566-573
pubmed: 23211635