The Library
Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi
Tools
Tools
Tools
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 ISSN 1932-6203.
|
PDF
WRAP-incremental-cost-effectiveness-screening-laser-treatment-diabetic-retinopathy-Madan-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1455Kb) | Preview |
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 | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 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 -- Malaŵi | |||||||||
| Journal or Publication Title: | PLoS One | |||||||||
| Publisher: | Public Library of Science | |||||||||
| ISSN: | 1932-6203 | |||||||||
| Official Date: | 4 January 2018 | |||||||||
| Dates: |
|
|||||||||
| 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 (Creative Commons) | |||||||||
| Date of first compliant deposit: | 24 April 2018 | |||||||||
| Date of first compliant Open Access: | 26 April 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
