title: Cost-utility analysis of screening for diabetic retinopathy in Japan: a probabilistic Markov modeling study.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness for a screening interval longer than 1 year detecting diabetic retinopathy (DR) through the estimation of incremental costs per quality-adjusted life year (QALY) based on the best available clinical data in Japan.
  
  
  METHODS
  A Markov model with a probabilistic cohort analysis was framed to calculate incremental costs per QALY gained by implementing a screening program detecting DR in Japan. A 1-year cycle length and population size of 50,000 with a 50-year time horizon (age 40-90 years) was used. Best available clinical data from publications and national surveillance data was used, and a model was designed including current diagnosis and management of DR with corresponding visual outcomes. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters.
  
  
  RESULTS
  In the base-case analysis, the strategy with a screening program resulted in an incremental cost of 5,147 Japanese yen (¥; US$64.6) and incremental effectiveness of 0.0054 QALYs per person screened. The incremental cost-effectiveness ratio was ¥944,981 (US$11,857) per QALY. The simulation suggested that screening would result in a significant reduction in blindness in people aged 40 years or over (-16%). Sensitivity analyses suggested that in order to achieve both reductions in blindness and cost-effectiveness in Japan, the screening program should screen those aged 53-84 years, at intervals of 3 years or less.
  
  
  CONCLUSIONS
  An eye screening program in Japan would be cost-effective in detecting DR and preventing blindness from DR, even allowing for the uncertainties in estimates of costs, utility, and current management of DR.
authors.affiliation: Department of Public Health, Yamagata University , Yamagata , Japan .
authors.forename: Ryo
authors.initials: R
authors.lastname: Kawasaki
authors.forename: Yoko
authors.initials: Y
authors.lastname: Akune
authors.forename: Yoshimune
authors.initials: Y
authors.lastname: Hiratsuka
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000191:economics*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007564:Japan; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D015351:Vision Screening / Q000191:economics*
keywords: Cost-utility analysis; Japan; Markov model; diabetic retinopathy; screening