title: Cost-Utility Analysis of Screening Strategies for Diabetic Retinopathy in Korea.
abstract: This study involved a cost-utility analysis of early diagnosis and treatment of diabetic retinopathy depending on the screening strategy used. The four screening strategies evaluated were no screening, opportunistic examination, systematic fundus photography, and systematic examination by an ophthalmologists. Each strategy was evaluated in 10,000 adults aged 40 yr with newly diagnosed diabetes mellitus (hypothetical cohort). The cost of each strategy was estimated in the perspective of both payer and health care system. The utility was estimated using quality-adjusted life years (QALY). Incremental Cost Effectiveness Ratio (ICER) for the different screening strategies was analyzed. After exclusion of the weakly dominating opportunistic strategy, the ICER of systematic photography was 57,716,867 and that of systematic examination by ophthalmologists was 419,989,046 from the perspective of the healthcare system. According to the results, the systematic strategy is preferable to the opportunistic strategy from the perspective of both a payer and a healthcare system. Although systematic examination by ophthalmologists may have higher utility than systematic photography, it is associated with higher cost. The systematic photography is the best strategy in terms of cost-utility. However systematic examination by ophthalmologists can also be a suitable policy alternative, if the incremental cost is socially acceptable.
authors.affiliation: Department of Ophthalmology, National Police Hospital, Seoul, Korea.
authors.forename: Sang-Won
authors.identifier: 0000-0003-4751-4298
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Gil-Won
authors.identifier: 0000-0003-0222-1870
authors.initials: GW
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics; D042241:Early Diagnosis; D005260:Female; D005451:Fluorescein Angiography / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D019057:Quality-Adjusted Life Years; D056910:Republic of Korea
keywords: Cost-utility Analysis; Diabetic Retinopathy; Markov Model; Quality-Adjusted Life Years (QALY)