The Library
Diabetic retinopathy and the use of laser photocoagulation : is it cost-effective to treat early?
Tools
Mistry, Hema, Auguste, Peter, Lois, Noemi and Waugh, Norman (2017) Diabetic retinopathy and the use of laser photocoagulation : is it cost-effective to treat early? BMJ Open Ophthalmology, 2 (1). e000021. doi:10.1136/bmjophth-2016-000021 ISSN 2397-3269.
|
PDF
WRAP-diabetic-retinopathy-laser-cost-effective-Mistry-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (955Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjophth-2016-000021
Abstract
Background/aims
The aim of the study was to explore whether it would be cost-effective to apply panretinal photocoagulation (PRP) at the severe non-proliferative diabetic retinopathy (NPDR) (early treatment) stage, compared with waiting until high-risk proliferative diabetic retinopathy (HR-PDR) characteristics (deferred treatment) developed.
Methods
A Markov model with a 30-year time horizon was developed, in which patients presenting with moderate NPDR could progress through all stages of DR (severe NPDR>early PDR>HR-PDR>severe PDR) to severe vision loss and blindness (and to death). A National Health Service and personal social services perspective was adopted. Transition probabilities were mainly 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 PRP at the severe NPDR stage could be 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%.
Conclusion
PRP administered at the severe NPDR stage is likely to be cost-effective compared with delaying photocoagulation until HR-PDR develops. However, given the limitations of the evidence, these results need 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 | ||||||
---|---|---|---|---|---|---|---|
Subjects: | R Medicine > RE Ophthalmology | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
||||||
Library of Congress Subject Headings (LCSH): | Diabetic retinopathy -- Treatment -- Cost effectiveness | ||||||
Journal or Publication Title: | BMJ Open Ophthalmology | ||||||
Publisher: | BMJ Group | ||||||
ISSN: | 2397-3269 | ||||||
Official Date: | 25 September 2017 | ||||||
Dates: |
|
||||||
Volume: | 2 | ||||||
Number: | 1 | ||||||
Article Number: | e000021 | ||||||
DOI: | 10.1136/bmjophth-2016-000021 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Date of first compliant deposit: | 23 February 2018 | ||||||
Date of first compliant Open Access: | 23 February 2018 | ||||||
RIOXX Funder/Project Grant: |
|
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |
Downloads
Downloads per month over past year