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Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi

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Vetrini, Damir, Kiire, Christine A., Burgess, Philip I. , Harding, Simon P., Kayange, Petros C., Kalua, Khumbo, Msukwa, Gerald, Beare, Nicholas A. V. and Madan, Jason (2018) Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. PLoS One, 13 (1). e0190742. doi:10.1371/journal.pone.0190742

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Official URL: https://doi.org/10.1371/journal.pone.0190742

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Abstract

Objective:

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.

Materials and methods:

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.

Results:

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%.

Conclusions:

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.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RF Otorhinolaryngology
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Diabetic retinopathy -- Treatment -- Cost effectiveness -- MalaƔi
Journal or Publication Title: PLoS One
Publisher: Public Library of Science
ISSN: 1932-6203
Official Date: 4 January 2018
Dates:
DateEvent
4 January 2018Published
10 December 2017Accepted
Volume: 13
Number: 1
Article Number: e0190742
DOI: 10.1371/journal.pone.0190742
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDBritish Council for Prevention of Blindnesshttp://dx.doi.org/10.13039/501100000367
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100004440

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