Individualised variable interval risk-based screening for sight threatening diabetic retinopathy – the Liverpool Risk Calculation Engine



Harding, SP ORCID: 0000-0003-4676-1158, Eleuteri, A, Fisher, AC, Broadbent, DM, Garcia-Finana, M, Cheyne, CP, Wang, A, Stratton, IM, Gabbay, M ORCID: 0000-0002-0126-8485 and Seddon, D
(2017) Individualised variable interval risk-based screening for sight threatening diabetic retinopathy – the Liverpool Risk Calculation Engine. Diabetologia, 60 (11). 2174 - 2182.

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Abstract

Aims/hypothesis Individualised variable-interval risk-based screening offers better targeting and improved cost-effectiveness in screening for diabetic retinopathy. We developed a generalisable risk calculation engine (RCE) to assign personalised intervals linked to local population characteristics, and explored differences in assignment compared with current practice. Methods Data from 5 years of photographic screening and primary care for people with diabetes, screen negative at the first of > 1 episode, were combined in a purpose-built near-real-time warehouse. Covariates were selected from a dataset created using mixed qualitative/quantitative methods. Markov modelling predicted progression to screen-positive (referable diabetic retinopathy) against the local cohort history. Retinopathy grade informed baseline risk and multiple imputation dealt with missing data. Acceptable intervals (6, 12, 24 months) and risk threshold (2.5%) were established with patients and professional end users. Results Data were from 11,806 people with diabetes (46,525 episodes, 388 screen-positive). Covariates with sufficient predictive value were: duration of known disease, HbA1c, age, systolic BP and total cholesterol. Corrected AUC (95% CIs) were: 6 months 0.88 (0.83, 0.93), 12 months 0.90 (0.87, 0.93) and 24 months 0.91 (0.87, 0.94). Sensitivities/specificities for a 2.5% risk were: 6 months 0.61, 0.93, 12 months 0.67, 0.90 and 24 months 0.82, 0.81. Implementing individualised RCE-based intervals would reduce the proportion of people becoming screen-positive before the allocated screening date by > 50% and the number of episodes by 30%. Conclusions/interpretation The Liverpool RCE shows sufficient performance for a local introduction into practice before wider implementation, subject to external validation. This approach offers potential enhancements of screening in improved local applicability, targeting and cost-effectiveness.

Item Type: Article
Uncontrolled Keywords: Diabetic retinopathy, Risk calculation engine, Risk-based screening
Depositing User: Symplectic Admin
Date Deposited: 18 Sep 2019 15:46
Last Modified: 08 May 2021 09:31
DOI: 10.1007/s00125-017-4386-0
Open Access URL: https://link.springer.com/content/pdf/10.1007/s001...
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3054831

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