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Cost effectiveness analysis of screening for sight threatening diabetic eye disease

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7250.1627 (Published 17 June 2000) Cite this as: BMJ 2000;320:1627

This article has a correction. Please see:

  1. Marilyn James, head of health economics (research and development) unit (m.james{at}keele.ac.uk)a,
  2. David A Turner, research fellowa,
  3. Deborah M Broadbent, clinical assistantb,
  4. Jiten Vora, consultant diabetologistc,
  5. Simon P Harding, consultant ophthalmologistb
  1. a Centre for Health Planning and Management, University of Keele, Keele, Staffordshire ST5 5BG
  2. b St Paul's Eye Unit, Royal Liverpool University Hospitals, Liverpool L7 8XP,
  3. c Department of Diabetes and Endocrinology, Royal Liverpool University Hospitals
  1. Correspondence to: M James
  • Accepted 13 March 2000

Abstract

Objective: To measure the cost effectiveness of systematic photographic screening for sight threatening diabetic eye disease compared with existing practice.

Design: Cost effectiveness analysis

Setting: Liverpool.

Subjects: A target population of 5000 diabetic patients invited for screening.

Main outcome measures: Cost effectiveness (cost per true positive) of systematic and opportunistic programmes; incremental cost effectiveness of replacing opportunistic with systematic screening.

Results: Baseline prevalence of sight threatening eye disease was 14.1%. The cost effectiveness of the systematic programme was £209 (sensitivity 89%, specificity 86%, compliance 80%, annual cost £104 996) and of the opportunistic programme was £289 (combined sensitivity 63%, specificity 92%, compliance 78%, annual cost £99 981). The incremental cost effectiveness of completely replacing the opportunistic programme was £32. Absolute values of cost effectiveness were highly sensitive to varying prevalence, sensitivity and specificity, compliance, and programme size.

Conclusion: Replacing existing programmes with systematic screening for diabetic eye disease is justified.

Footnotes

  • Funding This study was funded by North West Regional grant DIF1.

  • Competing interests None declared.

  • Accepted 13 March 2000
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