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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
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 | |||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RF Otorhinolaryngology |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Diabetic retinopathy -- Treatment -- Cost effectiveness -- Malaŵi | |||||||||
| Journal or Publication Title: | PLoS One | |||||||||
| Publisher: | Public Library of Science | |||||||||
| ISSN: | 1932-6203 | |||||||||
| Official Date: | 4 January 2018 | |||||||||
| Dates: |
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| Date of first compliant deposit: | 24 April 2018 | |||||||||
| 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: |
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