Cost effectiveness analysis of screening for sight threatening diabetic eye disease

doi:10.1136/bmj.320.7250.1627

BMJ 2000;320:1627-1631 ( 17 June )

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Cost effectiveness analysis of screening for sight threatening diabetic eye disease

Marilyn James, head of health economics (research and development) unit, ^a David A Turner, research fellow, ^a Deborah M Broadbent, clinical assistant, ^b Jiten Vora, consultant diabetologist, ^c Simon P Harding, consultant ophthalmologist. ^b

^a Centre for Health Planning and Management, University of Keele, Keele, Staffordshire ST5 5BG, ^b St Paul's Eye Unit, Royal Liverpool University Hospitals, Liverpool L7 8XP, ^c Department of Diabetes and Endocrinology, Royal Liverpool University Hospitals

Correspondence to: M James m.james{at}keele.ac.uk

Objective: To measure the cost effectiveness of systematicphotographic screening for sight threatening diabetic eye diseasecompared with existingpractice.
Design: Cost effectiveness analysis
Setting: Liverpool.
Subjects: A target population of 5000 diabetic patientsinvited forscreening.
Main outcome measures: Cost effectiveness (cost per true positive)of systematic and opportunistic programmes; incremental cost effectivenessof replacing opportunistic with systematicscreening.
Results: Baseline prevalence of sight threatening eyedisease was 14.1%. The cost effectiveness of the systematic programmewas £209 (sensitivity 89%, specificity 86%, compliance 80%, annualcost £104 996) and of the opportunistic programme was £289 (combinedsensitivity 63%, specificity 92%, compliance 78%, annual cost£99 981). The incremental cost effectiveness of completely replacingthe opportunistic programme was £32. Absolute values of cost effectivenesswere highly sensitive to varying prevalence, sensitivity and specificity,compliance, and programmesize.
Conclusion: Replacing existing programmes with systematicscreening for diabetic eye disease isjustified.

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