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

Author

Listed:
  • Ângela J. Ben

    (Vrije Universiteit Amsterdam)

  • Jeruza L. Neyeloff

    (Hospital de Clínicas de Porto Alegre)

  • Camila F. Souza

    (Universidade do Vale do Taquari)

  • Ana Paula O. Rosses

    (Federal University of Pelotas)

  • Aline L. Araujo

    (Telessaúde, Universidade Federal do Rio Grande do Sul)

  • Adriana Szortika

    (Hospital Moinhos de Vento)

  • Franciele Locatelli

    (Universidade Federal do Rio Grande do Sul)

  • Gabriela Carvalho

    (Universidade Federal do Rio Grande do Sul)

  • Cristina R. Neumann

    (Universidade Federal do Rio Grande do Sul)

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.

Suggested Citation

  • Ângela J. Ben & Jeruza L. Neyeloff & Camila F. Souza & Ana Paula O. Rosses & Aline L. Araujo & Adriana Szortika & Franciele Locatelli & Gabriela Carvalho & Cristina R. Neumann, 2020. "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, Springer, vol. 18(1), pages 57-68, February.
    • Handle: RePEc:spr:aphecp:v:18:y:2020:i:1:d:10.1007_s40258-019-00528-w
    DOI: 10.1007/s40258-019-00528-w
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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Elisabeth Fenwick & Bernie J. O'Brien & Andrew Briggs, 2004. "Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 405-415, May.
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