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The evaluation of screening policies for diabetic retinopathy using simulation

The evaluation of screening policies for diabetic retinopathy using simulation
The evaluation of screening policies for diabetic retinopathy using simulation
Aims: To develop a model for evaluating screening strategies and to use it to determine the cost effectiveness of varying the screening method and the screening interval.
Methods: A discrete event simulation was designed, validated and run for a population of 500 000. Most parameters were derived from peer-reviewed publications.
Results: Standard methods of screening save up to 50% of the potential sight years lost. They give up to 85% of the sight years saved by an idealized gold standard programme using mydriatic seven-field photography reported by an ophthalmologist. The mobile camera, used for annual screening and 6-month follow-up after the detection of background retinopathy, had an estimated cost of £449 200 per year with £2842 per sight year saved. It is less efficient to screen Type 2, rather than Type 1 diabetes mellitus patients, but they contributed to almost three-quarters of the sight years saved.
Conclusions: The model can evaluate screening intervals and methods on a national or health authority basis. Results indicate that it appears more cost effective to continue to screen outside an ophthalmology clinic, until treatment is needed. Programmes with annual screening, and more frequent screening for those with background retinopathy, are robust to realistic fluctuations in compliance and screening sensitivity.
diabetes mellitus, diabetic retinopathy, health planning, computer simulation, screening
0742-3071
762-770
Davies, R.
e978c85d-11eb-43e3-8db0-39334aa4b8d9
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Canning, C.
6cb6e055-58bb-4182-a690-0aaa340378e4
Brailsford, S.
634585ff-c828-46ca-b33d-7ac017dda04f
Davies, R.
e978c85d-11eb-43e3-8db0-39334aa4b8d9
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Canning, C.
6cb6e055-58bb-4182-a690-0aaa340378e4
Brailsford, S.
634585ff-c828-46ca-b33d-7ac017dda04f

Davies, R., Roderick, P., Canning, C. and Brailsford, S. (2002) The evaluation of screening policies for diabetic retinopathy using simulation. Diabetic Medicine, 19 (9), 762-770. (doi:10.1046/j.1464-5491.2002.00773.x).

Record type: Article

Abstract

Aims: To develop a model for evaluating screening strategies and to use it to determine the cost effectiveness of varying the screening method and the screening interval.
Methods: A discrete event simulation was designed, validated and run for a population of 500 000. Most parameters were derived from peer-reviewed publications.
Results: Standard methods of screening save up to 50% of the potential sight years lost. They give up to 85% of the sight years saved by an idealized gold standard programme using mydriatic seven-field photography reported by an ophthalmologist. The mobile camera, used for annual screening and 6-month follow-up after the detection of background retinopathy, had an estimated cost of £449 200 per year with £2842 per sight year saved. It is less efficient to screen Type 2, rather than Type 1 diabetes mellitus patients, but they contributed to almost three-quarters of the sight years saved.
Conclusions: The model can evaluate screening intervals and methods on a national or health authority basis. Results indicate that it appears more cost effective to continue to screen outside an ophthalmology clinic, until treatment is needed. Programmes with annual screening, and more frequent screening for those with background retinopathy, are robust to realistic fluctuations in compliance and screening sensitivity.

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More information

Published date: 2002
Keywords: diabetes mellitus, diabetic retinopathy, health planning, computer simulation, screening

Identifiers

Local EPrints ID: 24321
URI: http://eprints.soton.ac.uk/id/eprint/24321
ISSN: 0742-3071
PURE UUID: 3136abd8-cd4c-4562-bc83-2fb06a3384b1
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for S. Brailsford: ORCID iD orcid.org/0000-0002-6665-8230

Catalogue record

Date deposited: 30 Mar 2006
Last modified: 16 Mar 2024 02:48

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Contributors

Author: R. Davies
Author: P. Roderick ORCID iD
Author: C. Canning
Author: S. Brailsford ORCID iD

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