A personalised screening strategy for diabetic retinopathy: a cost-effectiveness perspective

Area of Science:

• Ophthalmology
• Endocrinology
• Health Economics

Background:

• Diabetic retinopathy (DR) is a leading cause of vision loss in people with diabetes.
• Current screening strategies for DR include annual screening and guidelines based on retinopathy grade.
• Personalized screening models offer a potential alternative for optimizing DR detection.

Purpose of the Study:

• To evaluate the cost-effectiveness of a personalized adaptive screening model for diabetic retinopathy.
• To compare this model against annual screening and the current Dutch guideline.
• To assess the trade-offs between diagnostic timeliness and cost savings.

Main Methods:

• A validated risk prediction model determined personalized screening intervals for individuals with type 2 diabetes.
• Observational data from 5514 patients (1998-2017) were analyzed.
• Cost-effectiveness was assessed from healthcare and societal perspectives, considering delayed sight-threatening retinopathy (STR) diagnoses.

Main Results:

• Personalized screening led to 11.6% more delayed STR diagnoses but €11.4 less cost per patient than annual screening (healthcare perspective).
• Compared to the Dutch guideline, personalized screening was slightly more expensive (€1.8/patient) but had 8.8% fewer delayed STR diagnoses.
• The personalized model demonstrated a favorable balance of cost savings and diagnostic outcomes.

Conclusions:

• The personalized diabetic retinopathy screening model is more cost-effective than the current Dutch guideline.
• While annual screening identified STR slightly faster, the personalized model's cost savings are substantial (€11.4 million annually in the Netherlands).
• Implementing personalized screening could lead to a small increase in delayed diagnoses but offers significant economic benefits.