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Article: Incorporating Optical Coherence Tomography Macula Scans Enhances Cost-effectiveness of Fundus Photography-Based Screening for Diabetic Macular Edema

TitleIncorporating Optical Coherence Tomography Macula Scans Enhances Cost-effectiveness of Fundus Photography-Based Screening for Diabetic Macular Edema
Authors
Issue Date2020
PublisherAmerican Diabetes Association. The Journal's web site is located at http://diabetes.diabetesjournals.org/
Citation
Diabetes Care, 2020, v. 43 n. 12, p. 2959-2966 How to Cite?
AbstractObjective: To compare four screening strategies for diabetic macular edema (DME). Research design and methods: Patients attending diabetic retinopathy screening were recruited and received macular optical coherence tomography (OCT), in addition to visual acuity (VA) and fundus photography (FP) assessments, as part of the standard protocol. Two retina specialists provided the reference grading by independently assessing each subject's screened data for DME. The current standard protocol (strategy A) was compared for sensitivity, specificity, quality-adjusted life-year (QALY) gained, and incremental cost-effectiveness ratio (ICER) with three alternative candidate protocols using a simulation model with the same subjects. In strategy B, macular hemorrhage or microaneurysm on FP were removed as surrogate markers for possible DME. Strategy C used best-corrected instead of habitual/pinhole VA and added central subfield thickness (CST) >290 μm on OCT in suspected cases as a confirmation marker for possible DME. Strategy D used CST >290 μm OCT in all subjects as a surrogate marker for suspected DME. Results: We recruited 2,277 subjects (mean age 62.80 ± 11.75 years, 43.7% male). The sensitivities and specificities were 40.95% and 86.60%, 22.86% and 95.63%, 32.38% and 100%, and 74.47% and 98.34% for strategy A, B, C, and D, respectively. The costs (in U.S. dollars) of each QALY gained for strategy A, B, C, and D were $7,447.50, $8,428.70, $5,992.30, and $4,113.50, respectively. Conclusions: The high false-positive rate of the current protocol generates unnecessary referrals, which are inconvenient for patients and costly for society. Incorporating universal OCT for screening DME can reduce false-positive results by eightfold, while improving sensitivity and long-term cost-effectiveness.
Persistent Identifierhttp://hdl.handle.net/10722/293204
ISSN
2020 Impact Factor: 19.112
2015 SCImago Journal Rankings: 5.827
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, IYH-
dc.contributor.authorWong, RLM-
dc.contributor.authorChan, JCH-
dc.contributor.authorKawasaki, R-
dc.contributor.authorChong, V-
dc.date.accessioned2020-11-23T08:13:19Z-
dc.date.available2020-11-23T08:13:19Z-
dc.date.issued2020-
dc.identifier.citationDiabetes Care, 2020, v. 43 n. 12, p. 2959-2966-
dc.identifier.issn0149-5992-
dc.identifier.urihttp://hdl.handle.net/10722/293204-
dc.description.abstractObjective: To compare four screening strategies for diabetic macular edema (DME). Research design and methods: Patients attending diabetic retinopathy screening were recruited and received macular optical coherence tomography (OCT), in addition to visual acuity (VA) and fundus photography (FP) assessments, as part of the standard protocol. Two retina specialists provided the reference grading by independently assessing each subject's screened data for DME. The current standard protocol (strategy A) was compared for sensitivity, specificity, quality-adjusted life-year (QALY) gained, and incremental cost-effectiveness ratio (ICER) with three alternative candidate protocols using a simulation model with the same subjects. In strategy B, macular hemorrhage or microaneurysm on FP were removed as surrogate markers for possible DME. Strategy C used best-corrected instead of habitual/pinhole VA and added central subfield thickness (CST) >290 μm on OCT in suspected cases as a confirmation marker for possible DME. Strategy D used CST >290 μm OCT in all subjects as a surrogate marker for suspected DME. Results: We recruited 2,277 subjects (mean age 62.80 ± 11.75 years, 43.7% male). The sensitivities and specificities were 40.95% and 86.60%, 22.86% and 95.63%, 32.38% and 100%, and 74.47% and 98.34% for strategy A, B, C, and D, respectively. The costs (in U.S. dollars) of each QALY gained for strategy A, B, C, and D were $7,447.50, $8,428.70, $5,992.30, and $4,113.50, respectively. Conclusions: The high false-positive rate of the current protocol generates unnecessary referrals, which are inconvenient for patients and costly for society. Incorporating universal OCT for screening DME can reduce false-positive results by eightfold, while improving sensitivity and long-term cost-effectiveness.-
dc.languageeng-
dc.publisherAmerican Diabetes Association. The Journal's web site is located at http://diabetes.diabetesjournals.org/-
dc.relation.ispartofDiabetes Care-
dc.rightsThis is an author-created, uncopyedited electronic version of an article accepted for publication in TITLE [Journal URL]. The American Diabetes Association (ADA), publisher of TITLE, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version is available online at [URL]-
dc.titleIncorporating Optical Coherence Tomography Macula Scans Enhances Cost-effectiveness of Fundus Photography-Based Screening for Diabetic Macular Edema-
dc.typeArticle-
dc.identifier.emailWong, IYH: wongyhi@hku.hk-
dc.identifier.emailChan, JCH: jonochan@hku.hk-
dc.identifier.authorityWong, IYH=rp01467-
dc.identifier.authorityWong, RLM=rp01394-
dc.identifier.authorityChan, JCH=rp02113-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.2337/dc17-2612-
dc.identifier.pmid33004465-
dc.identifier.hkuros319922-
dc.identifier.volume43-
dc.identifier.issue12-
dc.identifier.spage2959-
dc.identifier.epage2966-
dc.identifier.isiWOS:000590854800019-
dc.publisher.placeUnited States-

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