Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi

Vetrini, Damir, Kiire, Christine A, Burgess, Philip I ORCID: 0000-0002-3959-2299, Harding, Simon P ORCID: 0000-0003-4676-1158, Kayange, Petros C, Kalua, Khumbo, Msukwa, Gerald, Beare, Nicholas AV ORCID: 0000-0001-8086-990X and Madan, Jason (2018) Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi. PLOS ONE, 13 (1). e0190742-.

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Abstract

Objective To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa. Materials and methods A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed. Results In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%. Conclusions Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients.

Item Type:	Article
Uncontrolled Keywords:	Humans, Diabetic Retinopathy, Mass Screening, Markov Chains, Prospective Studies, Age Factors, Adult, Middle Aged, Cost-Benefit Analysis, Malawi, Macular Edema, Laser Therapy
Depositing User:	Symplectic Admin
Date Deposited:	15 Jan 2018 09:10
Last Modified:	19 Jan 2023 06:44
DOI:	10.1371/journal.pone.0190742
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3016116