Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System

Ângela J. Ben; Jeruza L. Neyeloff; Camila F. de Souza; Ana Paula O. Rosses; Aline L. de Araujo; Adriana Szortika; Franciele Locatelli; Gabriela de Carvalho; Cristina R. Neumann

doi:10.1007/s40258-019-00528-w

Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System

Ângela J. Ben^*
, Jeruza L. Neyeloff
, Camila F. de Souza
, Ana Paula O. Rosses
, Aline L. de Araujo
, Adriana Szortika
, Franciele Locatelli
, Gabriela de Carvalho
, Cristina R. Neumann

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective
To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System.

Methods
A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters’ uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018).

Results
Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = −0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively.

Conclusion
Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

Original language	English
Pages (from-to)	57-68
Number of pages	12
Journal	Applied health economics and health policy
Volume	18
Issue number	1
Early online date	1 Nov 2019
DOIs	https://doi.org/10.1007/s40258-019-00528-w
Publication status	Published - 2 Nov 2019

Funding

This study was funded by the Departamento de Ciência e Tecnologia—Ministério da Saúde do Brasil. Rede Brasileira de Avaliação de Tecnologias em Saúde: Pesquisa de Efetividade Comparativa (PEC-REBRATS). Grant no.: 57/2013 MCTI/CNPq/MS—SCTIE—DECIT.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Ben, Â. J., Neyeloff, J. L., de Souza, C. F., Rosses, A. P. O., de Araujo, A. L., Szortika, A., Locatelli, F., de Carvalho, G., & Neumann, C. R. (2019). Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System. Applied health economics and health policy, 18(1), 57-68. https://doi.org/10.1007/s40258-019-00528-w

@article{4bcc87349ea44afaa42daa269d8f1270,

title = "Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System",

abstract = "Objective To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. Methods A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters{\textquoteright} uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R\$32747 in 2018). Results Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R\$21445/QALY gained (\$9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R\$4) and less effective (incremental QALY = −0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. Conclusion Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.",

author = "Ben, \{{\^A}ngela J.\} and Neyeloff, \{Jeruza L.\} and \{de Souza\}, \{Camila F.\} and Rosses, \{Ana Paula O.\} and \{de Araujo\}, \{Aline L.\} and Adriana Szortika and Franciele Locatelli and \{de Carvalho\}, Gabriela and Neumann, \{Cristina R.\}",

year = "2019",

month = nov,

day = "2",

doi = "10.1007/s40258-019-00528-w",

language = "English",

volume = "18",

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Ben, ÂJ, Neyeloff, JL, de Souza, CF, Rosses, APO, de Araujo, AL, Szortika, A, Locatelli, F, de Carvalho, G & Neumann, CR 2019, 'Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System', Applied health economics and health policy, vol. 18, no. 1, pp. 57-68. https://doi.org/10.1007/s40258-019-00528-w

Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System. / Ben, Ângela J.; Neyeloff, Jeruza L.; de Souza, Camila F. et al.
In: Applied health economics and health policy, Vol. 18, No. 1, 02.11.2019, p. 57-68.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System

AU - Ben, Ângela J.

AU - Neyeloff, Jeruza L.

AU - de Souza, Camila F.

AU - Rosses, Ana Paula O.

AU - de Araujo, Aline L.

AU - Szortika, Adriana

AU - Locatelli, Franciele

AU - de Carvalho, Gabriela

AU - Neumann, Cristina R.

PY - 2019/11/2

Y1 - 2019/11/2

N2 - Objective To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. Methods A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters’ uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). Results Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = −0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. Conclusion Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

AB - Objective To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. Methods A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters’ uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). Results Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = −0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. Conclusion Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

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DO - 10.1007/s40258-019-00528-w

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JF - Applied health economics and health policy

IS - 1

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Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System

Abstract

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UN SDGs

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