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Economic Evaluation of Combined Screening for Multiple Blindness Eye Diseases in Rural and Urban China
19 Pages Posted: 6 Jul 2022
More...Abstract
Background: Most of vision impairment is avoidable, however, a routine screening programme is currently not availablein primary health care. The aim of this study was to evaluate the costs and benefits of a population screening programme for multiple blinding eye diseases in rural and urban China.
Methods: We developed a decision-analytic Markov model in a cohort of individuals from age 50 years through a total of 30 1-year cycles to calculate the cost-effectiveness and cost-utility of combined screening programs for multiple blinding eye diseases, including age-related macular degeneration, glaucoma, diabetic retinopathy, cataract, and pathologic myopia, from the societal perspective. We analysed rural and urban settings separately and considered with different screening delivery options (conventional screening, manual telescreening and AI telescreening) and frequencies. We calculated incremental cost-utility ratios (ICURs) using quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) in terms of the cost per blindness year avoided. One-way deterministic and simulated probabilistic sensitivity analyses were employed to assess the robustness.
Findings: Compared with no screening, combined eye disease screening satisfied the criterion for a highly cost-effective health intervention, with an ICUR of $1,823 and an ICER of $21,852 in rural setting. In urban areas, ICUR was $726 and ICER was $21,263. Manual telescreening is predicted to result in fewer costs and greater gain in health benefits. Notably, AI telescreening dominated no screening in the rural setting, and the ICUR for the urban setting was $465. All results were robust to sensitivity analyses. By further comparison, annual AI screening in rural areas and biennial AI screening in urban areas might be the most cost-effective strategy.
Interpretation: Combined eye diseases screening is cost-effective in both rural and urban China. AI coupled with teleophthalmology presents an opportunity to address promote equity in eye health.
Funding: National Natural Science Foundation of China (82171051)
Declaration of Interest: No conflicting relationship exists for any author.
Ethical Approval: The study was conducted according to the tenets of the Declaration of Helsinki and it was approved by the institutional review board of Beijing Tongren Hospital. Because the study was a retrospective review and analysis, the medical ethics committee declared it exempt from informed consent.
Keywords: cost-effectiveness, cost-utility, combined screening, telemedicine screening, multiple blindness eye diseases, AI-based screening
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