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Non-proliferative diabetic retinopathy : is it cost-effective to treat early?
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Mistry, Hema, Auguste, Peter, Lois, Noemi and Waugh, Norman (2014) Non-proliferative diabetic retinopathy : is it cost-effective to treat early? Value in Health, 17 (7). a609. doi:10.1016/j.jval.2014.08.2130 ISSN 1098-3015.
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Official URL: http://dx.doi.org/10.1016/j.jval.2014.08.2130
Abstract
Objectives
Diabetic retinopathy (DR) is a leading cause of sight loss in people of working age. There have been recent developments in laser photocoagulation techniques, along with anti-vascular endothelial growth factor drugs for the treatment of severe non-proliferative and proliferative DR. The aim of the study was to evaluate the cost-effectiveness of panretinal photocoagulation administered at the severe non-proliferative diabetic retinopathy (NPDR) stage (early treatment), compared with waiting until high-risk proliferative (HR-PDR) characteristics (deferred treatment) developed.
Methods
A Markov model with a 30-year time horizon was developed, with clinical pathway options for patients presenting with moderate NPDR through to irreversible-severe vision loss and blindness (and to death). Once patients entered a post-treatment health state they can progress to more severe health states, regress back to earlier stages of the disease, persist where they are, or die. NHS and personal social services perspective was adopted. Transition probabilities were based mainly on data derived from the Early Treatment Diabetic Retinopathy Study. Health state utilities, costs and complications were based on information from the literature, supplemented by expert opinion. Costs and outcomes were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted.
Results
Administering panretinal photocoagulation at the severe NPDR stage was more effective and less costly than waiting until HR-PDR developed. Sensitivity analyses gave similar results, with early treatment continuing to dominate deferred treatment. The probabilistic sensitivity analysis suggests that at willingness-to-pay threshold of £20-£30,000 per quality-adjusted life year, the probability of early treatment being cost-effective is 60%.
Conclusions
Panretinal photocoagulation administered at the severe NPDR stage is likely to be cost-effective. However, given the limitations of the evidence on current treatments, these results to be interpreted with caution. A trial of early versus deferred laser therapy is needed to provide better data based on modern treatments.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RE Ophthalmology | ||||||
Divisions: | 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 |
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Library of Congress Subject Headings (LCSH): | Diabetic retinopathy -- Diagnosis, Diabetic retinopathy -- Treatment -- Cost effectiveness | ||||||
Journal or Publication Title: | Value in Health | ||||||
Publisher: | Wiley-Blackwell Publishing, Inc | ||||||
ISSN: | 1098-3015 | ||||||
Official Date: | November 2014 | ||||||
Dates: |
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Volume: | 17 | ||||||
Number: | 7 | ||||||
Article Number: | a609 | ||||||
DOI: | 10.1016/j.jval.2014.08.2130 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access |
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