Improving the cost-effectiveness of photographic screening for diabetic macular oedema:a prospective, multi-centre, UK study


Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Optometry > Optometry
Additional Information: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
Uncontrolled Keywords: Ophthalmology,Sensory Systems,Cellular and Molecular Neuroscience
Full Text Link: http://aura.abd ... andle/2164/4265
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://bjo.bmj ... ntent/98/8/1042 (Publisher URL)
PURE Output Type: Article
Published Date: 2014-12-31
Published Online Date: 2014-03-28
Authors: Prescott, Gordon
Sharp, Peter
Goatman, Keith
Scotland, Graham
Fleming, Alan
Philip, Sam
Staff, Roger
Santiago, Cynthia
Borooah, Shyamanga
Broadbent, Deborah
Chong, Victor
Dodson, Paul
Harding, Simon
Leese, Graham
Megaw, Roly
Styles, Caroline
Swa, Ken
Wharton, Helen
Olson, John



Version: Accepted Version

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