Cost-utility Analysis of Opportunistic and Systematic Diabetic Retinopathy Screening Strategies from the Perspective of the Brazilian Public Healthcare System

Ângela J. Ben (), Jeruza L. Neyeloff, Camila F. Souza, Ana Paula O. Rosses, Aline L. Araujo, Adriana Szortika, Franciele Locatelli, Gabriela Carvalho and Cristina R. Neumann
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Ângela J. Ben: Vrije Universiteit Amsterdam
Jeruza L. Neyeloff: Hospital de Clínicas de Porto Alegre
Camila F. Souza: Universidade do Vale do Taquari
Ana Paula O. Rosses: Federal University of Pelotas
Aline L. Araujo: Telessaúde, Universidade Federal do Rio Grande do Sul
Adriana Szortika: Hospital Moinhos de Vento
Franciele Locatelli: Universidade Federal do Rio Grande do Sul
Gabriela Carvalho: Universidade Federal do Rio Grande do Sul
Cristina R. Neumann: Universidade Federal do Rio Grande do Sul

Applied Health Economics and Health Policy, 2020, vol. 18, issue 1, No 6, 57-68

Abstract: Abstract Objective To perform a cost-utility analysis of diabetic retinopathy (DR) screening strategies from the perspective of the Brazilian Public Healthcare System. Methods A model-based economic evaluation was performed to estimate the incremental costs per quality-adjusted life-year (QALY) gained between three DR screening strategies: (1) the opportunistic ophthalmology referral-based (usual practice), (2) the systematic ophthalmology referral-based, and (3) the systematic teleophthalmology-based. The target population included individuals with type 2 diabetes (T2D) aged 40 years, without retinopathy, followed over a 40-year time horizon. A Markov model was developed with five health states and a 1-year cycle. Model parameters were based on literature and country databases. One-way and probabilistic sensitivity analyses were performed to assess model parameters’ uncertainty. WHO willingness-to-pay (WHO-WTP) thresholds were used as reference (i.e. one and three times the Brazilian per capita Gross Domestic Product of R$32747 in 2018). Results Compared to usual practice, the systematic teleophthalmology-based screening was associated with an incremental cost of R$21445/QALY gained ($9792/QALY gained). The systematic ophthalmology referral-based screening was more expensive (incremental costs = R$4) and less effective (incremental QALY = −0.012) compared to the systematic teleophthalmology-based screening. The probability of systematic teleophthalmology-based screening being cost-effective compared to usual practice was 0.46 and 0.67 at the minimum and the maximum WHO-WTP thresholds, respectively. Conclusion Systematic teleophthalmology-based DR screening for the Brazilian population with T2D would be considered very cost effective compared to the opportunistic ophthalmology referral-based screening according to the WHO-WTP threshold. However, there is still a considerable amount of uncertainty around the results.

Date: 2020
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DOI: 10.1007/s40258-019-00528-w

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