title: Cost of diabetic retinopathy and macular oedema in a population, an eight year follow up.
abstract: BACKGROUND
  Prospective, population-based study of an 8-year follow up. To determine the direct cost of diabetic retinopathy [DR], evaluating our screening programme and the cost of treating DR, focusing on diabetic macular oedema [DMO] after anti-vascular endothelial growth factor [anti-VEGF] treatment.
  
  
  METHODS
  A total of 15,396 diabetes mellitus [DM] patients were studied. We determined the cost-effectiveness of our screening programme against an annual programme by applying the Markov simulation model. We also compared the cost-effectiveness of anti-VEGF treatment to laser treatment for screened patients with DMO.
  
  
  RESULTS
  The cost of our 2.5-year screening programme was as follows: per patient with any-DR, €482.85 ± 35.14; per sight-threatening diabetic retinopathy [STDR] patient, €1528.26 ± 114.94; and €1826.98 ± 108.26 per DMO patient. Comparatively, an annual screening programme would result in increases as follows: 0.77 in QALY per patient with any-DR and 0.6 and 0.44 per patient with STDR or DMO, respectively, with an incremental cost-effective ratio [ICER] of €1096.88 for any-DR, €4571.2 for STDR and €7443.28 per DMO patient. Regarding diagnosis and treatment, the mean annual total cost per patient with DMO was €777.09 ± 49.45 for the laser treated group and €7153.62 ± 212.15 for the anti-VEGF group, with a QALY gain of 0.21, the yearly mean cost was €7153.62 ± 212.15 per patient, and the ICER was €30,361.
  
  
  CONCLUSIONS
  Screening for diabetic retinopathy every 2.5 years is cost-effective, but should be adjusted to a patient's personal risk factors. Treatment with anti-VEGF for DMO has increased costs, but the cost-utility increases to 0.21 QALY per patient.
authors.affiliation: Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain. romeropere@gmail.com.|Hospital Universtario Sant Joan, Avenida. Doctor. Josep Laporte 2, 43204, Reus, Spain. romeropere@gmail.com.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0002-7061-8987
authors.initials: P
authors.lastname: Romero-Aroca
authors.affiliation: Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain.
authors.forename: Sofia
authors.initials: S
authors.lastname: de la Riva-Fernandez
authors.affiliation: Department of Computer Engineering and Mathematics, University Rovira and Virgili, Reus, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Valls-Mateu
authors.affiliation: Health Care Area Reus-Priorat, Reus, Spain.|Institut Catala de la Salut [ICS], Barcelona, Spain.|Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Sagarra-Alamo
authors.affiliation: Department of Computer Engineering and Mathematics, University Rovira and Virgili, Reus, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Moreno-Ribas
authors.affiliation: Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Soler
authors.affiliation: Department of Computer Engineering and Mathematics, University Rovira and Virgili, Reus, Spain.
authors.forename: Domenec
authors.initials: D
authors.lastname: Puig
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000191:economics*; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000191:economics; D008269:Macular Edema / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D042461:Vascular Endothelial Growth Factor A; D014821:Vitrectomy / Q000191:economics*
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A
keywords: Cost of diabetic macular oedema; Cost of diabetic retinopathy screening; Diabetic macular oedema; Diabetic retinopathy; Telemedicine