Évaluation économique a priori du dépistage de la rétinopathie diabétique par photographies du fond d‘œil

Abstract

SUMMARY
ECONOMIC EVALUATION OF EARLY SCREENING FOR DIABETIC RETINOPA-THY USING FUNDUS PHOTOGRAPHY
Background: Diabetic retinopathy (DR) is the leading cause of blindness in people younger than 60 years in the general population.
Objective: To assess the relevance and modalities of early screening for diabetic retinopa-thy using fundus photography.
Methods: A Markov model based on a health insurance perspective was developed to eval-uate 17 screening strategies; the model simulated the fate of patient cohorts with or without diabetic retinopathy over 10 years. Six health states which mimicked the natural history of the disease were modeled: no retinopathy, background retinopathy, mild pre-proliferative retinopa-thy, sight threatening retinopathy, severe visual impairment, and death. Key modalities of the screening where type of screening (mass screening with or without dilatation, and opportunis-tic screening), rhythm (annual, biennial, or triennial) and addressing threshold. Yearly transi-tional probabilities were estimated from the Liverpool Diabetic Eyes study (LDES). Cost cal-culations were made from the point of view of prevention spending in relation to diabetic retinopathy and cost data was obtained from the French health insurance database. A discounting rate of 4% per annum was applied to each cost and effectiveness parameter. The cycle length was 12 months. The primary endpoint of the study was the number of prevented visual impair-ment. Cost-effective strategies were identified and deterministic sensitivity analysis was carried out on the results.