COST-EFFECTIVENESS OF DIABETIC RETINOPATHY SCREENING IN CHINA

Purpose: Diabetic retinopathy (DR) screening with regular screening interval has shown to be very cost-effective in developed countries.  The question remains whether we can adjust the screening interval to produce optimum benefit at a cost which is affordable for China. This study examined the costs, benefits and cost-effectiveness of differential screening intervals in a population with type 2 diabetes in China. 

Method(s): The public health care funder's perspective was adopted. Subjects were defined as at high risk of developing proliferative DR (PDR) if they had non-proliferative DR (NPDR) at the initial screen or at low risk if they had no DR. A decision model was developed to evaluate six screening strategies against no screening, including screening every 1, 2 or 3 years for all or at different intervals for those at high risk: 1, 2, or 3 year interval, or low risk: 5 or 10 years or no follow-up screening. A Markov model was built to simulate the progression of DR in a hypothetical cohort of patients with diabetes aged 50 and above in China.  Model parameters were derived from Chinese data where possible or overseas published studies. Incremental cost effectiveness ratios (ICER) were calculated.

Result(s): Assuming a threshold of willingness to pay for a sight year saved based on 1 per capita GDP (￥35,083) in China, the most cost-effective screening strategy was 5-yearly screening for low-risk subjects and 1-yearly screening for high-risk subjects with an ICER of ￥17,823 per sight year saved.  

Conclusion(s): Using risk-based screening intervals may help protect vision at an affordable cost in China.