Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi.
To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa.A cohort Markov model was b...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5754125?pdf=render |
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| author | Damir Vetrini Christine A Kiire Philip I Burgess Simon P Harding Petros C Kayange Khumbo Kalua Gerald Msukwa Nicholas A V Beare Jason Madan |
| author_facet | Damir Vetrini Christine A Kiire Philip I Burgess Simon P Harding Petros C Kayange Khumbo Kalua Gerald Msukwa Nicholas A V Beare Jason Madan |
| author_sort | Damir Vetrini |
| collection | DOAJ |
| description | To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa.A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed.In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%.Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients. |
| first_indexed | 2024-04-13T01:59:49Z |
| format | Article |
| id | doaj.art-c4c3855421ef456ba7d55ade48805a0c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T01:59:49Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-c4c3855421ef456ba7d55ade48805a0c2022-12-22T03:07:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01131e019074210.1371/journal.pone.0190742Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi.Damir VetriniChristine A KiirePhilip I BurgessSimon P HardingPetros C KayangeKhumbo KaluaGerald MsukwaNicholas A V BeareJason MadanTo investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa.A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed.In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%.Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients.http://europepmc.org/articles/PMC5754125?pdf=render |
| spellingShingle | Damir Vetrini Christine A Kiire Philip I Burgess Simon P Harding Petros C Kayange Khumbo Kalua Gerald Msukwa Nicholas A V Beare Jason Madan Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. PLoS ONE |
| title | Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. |
| title_full | Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. |
| title_fullStr | Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. |
| title_full_unstemmed | Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. |
| title_short | Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. |
| title_sort | incremental cost effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in malawi |
| url | http://europepmc.org/articles/PMC5754125?pdf=render |
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