Observational studyPloS one2018
Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi.
Observational study in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 20 citations in OpenAlex.
- Costs and cost-effectiveness of the Kerala pilot screening programme for diabetic retinopathy in the public health system.Eye (London, England) · 2024Article
- The use of social simulation modelling to understand adherence to diabetic retinopathy screening programs.Scientific reports · 2024Article
- Review
- Prevalence and associated factors of diabetic retinopathy among people with diabetes screened using fundus photography at a community diabetic retinopathy screening program in Nepal.BMC ophthalmology · 2023Article
- Does the Choice of Health Metric, DALY or QALY, Influence Conclusions of Health Economic Evaluation? A Case Study of Rotavirus Vaccine in Burundi.Applied health economics and health policy · 2022Article
- Regional variation in diabetic retinopathy and associated factors in Spectrum of Eye Disease in Diabetes (SPEED) study in India-Report 5.Indian journal of ophthalmology · 2021Article
- Recently updated global diabetic retinopathy screening guidelines: commonalities, differences, and future possibilities.Eye (London, England) · 2021Review
- Fundamental principles of an effective diabetic retinopathy screening program.Acta diabetologica · 2020Article
- A Survey of the Management of Diabetic Macular Oedema in Sub-Saharan Africa.Nigerian medical journal : journal of the Nigeria Medical AssociationArticle
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 3 countries.
Funding
Abstract
objectiveTo 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
methodsA 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.
resultsIn 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%.
conclusionsAnnual 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.