The cost-effectiveness of three screening alternatives for people with diabetes with no or early diabetic retinopathy

Health Services Research

Volumn 46, Issue 5, 2011, Pages 1534-1561

  Rein, David B ^a   Wittenborn, John S ^a   Zhang, Xinzhi ^b   Allaire, Benjamin A ^a   Song, Michael S ^a   Klein, Ronald ^c   Saaddine, Jinan B ^b  

^a RTI INTERNATIONAL   (United States)

^b NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION   (United States)

^c UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH   (United States)

Author keywords

Cost effectiveness; diabetes care; ophthalmology; simulation modeling; telemedicine

Indexed keywords

ADULT; AGED; ARTICLE; COST EFFECTIVENESS ANALYSIS; DIABETES MELLITUS; DIABETIC RETINOPATHY; EYE EXAMINATION; GLAUCOMA; HUMAN; MAJOR CLINICAL STUDY; MONTE CARLO METHOD; REFRACTION ERROR; RETINAL DIGITAL PHOTOGRAPHY; TELEMEDICINE; VISUAL IMPAIRMENT;

ADULT; AGED; AGED, 80 AND OVER; COST-BENEFIT ANALYSIS; DIABETIC RETINOPATHY; FEMALE; GREAT BRITAIN; HEALTH SERVICES RESEARCH; HUMANS; MALE; MASS SCREENING; MIDDLE AGED; MONTE CARLO METHOD; NUTRITION SURVEYS; PREVALENCE; QUALITY-ADJUSTED LIFE YEARS; RISK ASSESSMENT; TELEMEDICINE; UNITED STATES;

EID: 80052528866     PISSN: 00179124     EISSN: 14756773     Source Type: Journal    
DOI: 10.1111/j.1475-6773.2011.01263.x     Document Type: Article

References (76)

1. Age-Related Eye Disease Study Research Group. 2001. " A Randomized, Placebo-Controlled Clinical Trial of High-Dose Supplementation with Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss. AREDS Report No. 8. Archives of Ophthalmology 119: 1417-36.
2. Ahmed, J., T. P. Ward, S. E. Bursell, L. M. Aiello, J. D. Cavallerano, and, R. A. Vigersky,. 2006. " The Sensitivity and Specificity of Nonmydriatic Digital Stereoscopic Retinal Imaging in Detecting Diabetic Retinopathy. Diabetes Care 29 (10): 2205-9. (Pubitemid 44899853)
3. American Academy of Ophthalmology Retina Panel. 2008. Preferred Practice Pattern: Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology.
4. American Medical Association. 2007. CPT 2006: Current Procedural Terminology (Standard Edition). Florence, KY: Thomson Delmar Learning.
5. Arias, E., 2007. " United States Life Tables, 2004." In National Vital Statistics Reports, edited by D. V. Miller, pp. 1-40. Hyattsville, MD: National Center for Health Statistics.
6. Asefzadeh, B., and, L. R. Pasquale,. 2008. " Detection of Glaucoma-Like Optic Discs in a Diabetes Teleretinal Program. Optometry 79: 560.
7. Bonovas, S., V. Peponis, and, K. Filioussi,. 2004. " Diabetes Mellitus as a Risk Factor for Primary Open-Angle Glaucoma: A Meta-Analysis. Diabetic Medicine 21 (6): 609-14. (Pubitemid 38746283)
8. Brown, G. C., M. M. Brown, and, S. Sharma,. 2000. " How Often Should Patients with Diabetes Be Screened for Retinopathy? Journal of the American Medical Association 284 (4): 438; author reply 439.
9. Brown, M. M., G. C. Brown, S. Sharma, and, B. Busbee,. 2003a. " Quality of Life Associated with Visual Loss: A Time Tradeoff Utility Analysis Comparison with Medical Health States. Ophthalmology 110: 1076-81.
10. Brown, M. M., G. C. Brown, S. Sharma, J. Kistler, and, H. Brown,. 2001. " Utility Values Associated with Blindness in an Adult Population. British Journal of Ophthalmology 85: 327-31. (Pubitemid 32250764)
11. Brown, M. M., G. C. Brown, S. Sharma, and, J. Landy,. 2003b. " Health Care Economic Analyses and Value-Based Medicine. Survey of Ophthalmology 48 (2): 204-23. (Pubitemid 36398575)
12. Cavallerano, A. A., J. D. Cavallerano, P. Katalinic, A. M. Tolson, L. P. Aiello, and, L. M. Aiello,. 2003. " Use of Joslin Vision Network Digital-Video Nonmydriatic Retinal Imaging to Assess Diabetic Retinopathy in a Clinical Program. Retina 23 (2): 215-23. (Pubitemid 36548815)
13. Chow, S. P., L. M. Aiello, J. D. Cavallerano, P. Katalinic, K. Hock, A. Tolson, R. Kirby, S. E. Bursell, and, L. P. Aiello,. 2006. " Comparison of Nonmydriatic Digital Retinal Imaging versus Dilated Ophthalmic Examination for Nondiabetic Eye Disease in Persons with Diabetes. Ophthalmology 113 (5): 833-40. (Pubitemid 44294300)
14. Clemons, T. E., N. Kurinij, and, R. D. Sperduto,. 2004. " Associations of Mortality with Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study: AREDS Report No. 13. Archives of Ophthalmology 122 (5): 716-26. (Pubitemid 38607400)
15. Clemons, T. E., R. C. Milton, R. Klein, J. M. Seddon, and, F. L. III Ferris,. 2005. " Risk Factors for the Incidence of Advanced Age-Related Macular Degeneration in the Age-Related Eye Disease Study (AREDS) AREDS Report No. 19. Ophthalmology 112 (4): 533-9. (Pubitemid 41108849)
16. Dasbach, E., D. Fryback, P. Newcomb, R. Klein, and, B. Klein,. 1991. " Cost-Effectiveness of Strategies for Detecting Diabetic Retinopathy. Medical Care 29 (1): 20-39.
17. Deb-Joardar, N., N. Germain, G. Thuret, A. F. Garcin, P. Manoli, A. Defreyn, P. Gain, and, B. Estour,. 2007. " Systematic Screening for Diabetic Retinopathy with a Digital Fundus Camera Following Pupillary Dilatation in a University Diabetes Department. Diabetic Medicine 24 (3): 303-7.
18. Diabetic Retinopathy Study Research Group. 1987. " Indications for Photocoagulation Treatment of Diabetic Retinopathy: DRS Report No. 14. International Ophthalmology Clinics 27 (4): 239-53.
19. Dong, F., C. Orians, and, D. Manninen,. 1997. Economic Evaluation of Approaches to Preventing Diabetic End-Stage Renal Disease. Seattle, WA: Prepared for the Centers for Disease Control and Prevention by Battelle-Centers for Public Health Research and Evaluation.
20. Doubilet, P., C. B. Begg, M. C. Weinstein, P. Braun, and, B. J. McNeil,. 1985. " Probabilistic Sensitivity Analysis Using Monte Carlo Simulation: A Practical Approach. Medical Decision Making 5: 157-77. (Pubitemid 16130640)
21. Early Treatment Diabetic Retinopathy Study Research Group. 1985. " Photocoagulation for Diabetic Macular Edema: ETDRS Report No. 1. Archives of Ophthalmology 103: 1796-806.
22. Early Treatment Diabetic Retinopathy Study Research Group. 1991. " Early Photocoagulation for Diabetic Retinopathy. ETDRS Report Number 9. Ophthalmology 98 (5): 766-85.
23. Early Treatment Diabetic Retinopathy Study Research Group. 1995. " Focal Photocoagulation Treatment of Diabetic Macular Edema. Relationship of Treatment Effect to Fluorescein Angiographic and Other Retinal Characteristics at Baseline: ETDRS Report No. 19. Archives of Ophthalmology 113: 1144-55.
24. The Eye Diseases Prevalence Research Group. 2004. " Causes and Prevalence of Visual Impairment among Adults in the United States. Archives of Ophthalmology 122: 477-85.
25. Fodera, F. A., 1999. " Diabetes: Diagnosis, Management and Patient Education. Clinical Eye and Vision Care 11: 183-6.
26. Fong, D. S., L. Aiello, T. W. Gardner, G. L. King, G. Blankenship, J. D. Cavallerano, F. L. Ferris, and, R. Klein,. 2003. " Diabetic Retinopathy. Diabetes Care 26 (1): S99-102. (Pubitemid 36934460)
27. Fransen, S., T. Leonard-Martin, W. Feuer, and, P. L. Hildebrand,. 2002. " Clinical Evaluation of Patients with Diabetic Retinopathy: Accuracy of the Inoveon Diabetic Retinopathy-3DT System. Ophthalmology 109 (3): 595-601.
28. Freeman, E. E., B. L. Egleston, S. K. West, K. Bandeen-Roche, and, G. Rubin,. 2005. " Visual Acuity Change and Mortality in Older Adults. Investigative Ophthalmology and Visual Science 46 (11): 4040-5. (Pubitemid 44268953)
29. Gold, M. R., P. Franks, K. I. McCoy, and, D. G. Fryback,. 1998. " Toward Consistency in Cost-Utility Analyses: Using National Measures to Create Condition-Specific Values. Medical Care 36 (6): 778-92.
30. Gold, M. R., J. E. Seigal, L. B. Russell, and, M. C. Weinstein,. 1996. Cost-effectiveness in Health and Medicine. Oxford, England, U.K.: Oxford University Press.
31. Gray, L., and, J. Parkinson,. 2003. The Essential RBRVS. Salt Lake City, UT: St. Anthoney's Publishing.
32. Harper, R., and, B. Reeves,. 2000. " The Sensitivity and Specificity of Direct Ophthalmoscopic Optic Disc Assessment in Screening for Glaucoma: A Multivariate Analysis. Graefe's Archive for Clinical and Experimental Ophthalmology 238 (12): 949-55. (Pubitemid 32004647)
33. Heijl, A., M. C. Leske, B. Bengtsson, L. Hyman, B. Bengtsson, and, M. Hussein,. 2002. " Reduction of Intraocular Pressure and Glaucoma Progression-Results from the Early Manifest Glaucoma Trial. Archives of Ophthalmology 120 (10): 1268-79. (Pubitemid 36105431)
34. Hoerger, T. J., R. Harris, K. A. Hicks, K. Donahue, S. Sorensen, and, M. Engelgau,. 2004. " Screening for Type 2 Diabetes Mellitus: A Cost-Effectiveness Analysis. Annals of Internal Medicine 140 (9): 689-99.
35. Hoskins, H. D. Jr., 2000. " How Often Should Patients with Diabetes Be Screened for Retinopathy? Journal of the American Medical Association 284 (4): 438-9.
36. Hovind, P., L. Tarnow, K. Rossing, P. Rossing, S. Eising, N. Larsen, C. Binder, and, H. H. Parving,. 2003. " Decreasing Incidence of Severe Diabetic Microangiopathy in Type 1 Diabetes. Diabetes Care 26 (4): 1258-64. (Pubitemid 36929282)
37. Javitt, J., and, L. Aiello,. 1996. " Cost-Effectiveness of Detecting and Treating Diabetic Retinopathy. Annals of Internal Medicine 124 (1, Part 2): 164-9. (Pubitemid 26011617)
38. Javitt, J. C., 1995. " Cost Savings Associated with Detection and Treatment of Diabetic Eye Diseases. PharmacoEconomics 8 (Suppl. 1): 33-9.
39. Javitt, J. C., 2000. " How Often Should Patients with Diabetes Be Screened for Retinopathy? Journal of the American Medical Association 284 (4): 437-8; author reply 39.
40. Javitt, J. C., L. P. Aiello, Y. Chiang, F. L. Ferris, J. K. Canner, and, S. Greenfield,. 1994. " Preventive Eye Care in People with Diabetes Is Cost-Saving to the Federal Government. Diabetes Care 17 (8): 909-17. (Pubitemid 24235519)
41. Klein, R., and, B. E. Klein,. 2010. " Are Individuals with Diabetes Seeing Better? A Long-Term Epidemiological Perspective. Diabetes 59 (8): 1853-60.
42. Klein, R., B. E. K. Klein, S. E. Moss, and, K. J. Cruikshanks,. 1994. " The Wisconsin Epidemiologic Study of Diabetic Retinopathy XIV. Ten-year Incidence and Progression of Diabetic Retinopathy. Archives of Ophthalmology 112: 1217-28. (Pubitemid 24360961)
43. Klein, R., 1995. " The Wisconsin Epidemiologic Study of Diabetic Retinopathy XV. The Long-Term Incidence of Macular Edema. Ophthalmology 102: 7-16.
44. Klein, R., B. E. K. Klein, S. E. Moss, M. D. Davis, and, D. L. DeMets,. 1984. " The Wisconsin Epidemiologic Study of Diabetic Retinopathy III. Prevalence and Risk of Diabetic Retinopathy When Age at Diagnosis Is 30 or More Years. Archives of Ophthalmology 102: 527-32. (Pubitemid 14127839)
45. Klein, R., and, K. E. Lee,. 2009. " Changes in Visual Impairment Prevalence by Period of Diagnosis of Diabetes: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmology 116 (10): 1937-42.
46. Knudtson, M. D., B. E. Klein, and, R. Klein,. 2006. " Age-Related Eye Disease, Visual Impairment, and Survival: The Beaver Dam Eye Study. Archives of Ophthalmology 124 (2): 243-9. (Pubitemid 43247075)
47. Kohner, E. M., I. M. Stratton, S. J. Aldington, R. R. Holman, and, D. R. Matthews,. 2001. " UKPDS 52: Relationship between the Severity of Retinopathy and Progresion to Photocoagulation in Patients with Type 2 Diabetes Mellitus in the UKPDS. Diabetic Medicine 18: 178-84.
48. Lee, V. S., R. M. Kingsley, E. T. Lee, M. Lu, D. Russell, N. R. Asal, R. H. Jr. Bradford, and, C. P. Wilkinson,. 1993. " The Diagnosis of Diabetic Retinopathy. Ophthalmoscopy versus Fundus Photography. Ophthalmology 100 (10): 1504-12. (Pubitemid 23292861)
49. Leibson, C. L., J. P. Burke, J. E. Ransom, J. Forsgren, J. Melton, K. R. Bailey, and, P. J. Palumbo,. 2005. " Relative Risk of Mortality Associated with Diabetes as a Function of Birth Weight. Diabetes Care 28 (12): 2839-43. (Pubitemid 43942912)
50. Leske, M. C., A. Heijl, M. Hussein, B. Bengtsson, L. Hyman, and, E. Komaroff,. 2003. " Factors for Glaucoma Progression and the Effect of Treatment-the Early Manifest Glaucoma Trial. Archives of Ophthalmology 121 (1): 48-56. (Pubitemid 36401765)
51. Luo, H. D., G. Gazzard, Y. Liang, A. Shankar, D. T. Tan, and, S. M. Saw,. 2006. " Defining Myopia Using Refractive Error and Uncorrected LogMAR Visual Acuity >0.3 from 1334 Singapore School Children Ages 7-9 Years. British Journal of Ophthalmology 90 (3): 362-6. (Pubitemid 43325472)
52. Macular Photocoagulation Study Group. 1991. " Argon Laser Photocoagulation for Neovascular Maculopathy. Five Year Results from Randomized Clinical Trials. Archives of Ophthalmology 109: 1109-14.
53. Moss, S., R. Klein, S. Kessler, and, K. Richie,. 1985. " Comparison between Ophthalmoscopy and Fundus Photography in Determining Severity of Diabetic Eye Disease. Ophthalmology 92: 62-7. (Pubitemid 15170415)
54. National Center for Chronic Disease Prevention and Health Promotion. 2009. "National Diabetes Fact Sheet" [accessed on October 13, 2009]. Available at
55. National Center for Health Statistics. 2005-2006. National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services.
56. O'Hagan, A., and, B. R. Luce,. 2003. A Primer on Bayesian Statistics in Health Economics and Outcomes Research. Centre for Bayesian Statistics in Health Economics, MEDTAP International Inc., London. Available at
57. O'Hagan, A., M. Stevenson, and, J. Madan,. 2007. " Monte Carlo Probabilistic Sensitivity Analysis for Patient Level Simulation Models: Efficient Estimation of Mean and Variance Using ANOVA. Health Economics 16 (10): 1009-23.
58. Pasquale, L. R., B. Asefzadeh, R. W. Dunphy, B. M. Fisch, and, P. R. Conlin,. 2007. " Detection of Glaucoma-Like Optic Discs in a Diabetes Teleretinal Program. Optometry 78: 657-63.
59. Rein, D. B., J. B. Saaddine, J. S. Wittenborn, K. E. Wirth, T. J. Hoerger, K. M. Narayan, T. Clemons, and, S. W. Sorensen,. 2007a. " Cost-Effectiveness of Vitamin Therapy for Age-Related Macular Degeneration. Ophthalmology 114 (7): 1319-26. (Pubitemid 47001505)
60. Rein, D. B., K. W. Wirth, C. A. Johnson, and, P. P. Lee,. 2007b. " Estimating Quality-Adjusted Life Year Losses Associated with Visual Field Deficits Using Methodological Approaches. Ophthalmic Epidemiology 14: 258-64. (Pubitemid 47493727)
61. Rein, D. B., J. S. Wittenborn, P. P. Lee, K. E. Wirth, S. W. Sorensen, T. J. Hoerger, and, J. B. Saaddine,. 2009. " The Cost-Effectiveness of Routine Office-Based Identification and Subsequent Medical Treatment of Primary Open-Angle Glaucoma. Ophthalmology 116: 823-32.
62. Rein, D. B., P. Zhang, K. E. Wirth, P. P. Lee, T. J. Hoerger, N. McCall, R. Klein, J. M. Tielsch, S. Vijan, and, J. Saaddine,. 2006. " The Economic Burden of Major Adult Visual Disorders in the United States. Archives of Ophthalmology 124 (12): 1754-60. (Pubitemid 44920172)
63. Sloan, F. A., D. S. Brown, E. S. Carlisle, G. A. Picone, and, P. P. Lee,. 2004. " Monitoring Visual Status: Why Patients Do or Do Not Comply with Practice Guidelines. Health Services Research 39 (5): 1429-48.
64. Stevens, R. J., I. M. Stratton, and, R. R. Holman,. 2002. " UKPDS 58: Modeling Glucose Exposure as a Risk Factor for Photocoagulation in Type 2 Diabetes. Journal of Diabetes and its Complications 16: 371-6.
65. Stratton, I. M., E. M. Kohner, S. J. Aldington, R. C. Turner, R. R. Holman, S. E. Manley, and, D. R. Matthews,. 2001. " UKPDS 50: Risk Factors for Incidence and Progression of Retinopathy in Type II Diabetes Over 6 Years from Diagnosis. Diabatologia 44: 156-63.
66. Taylor, C., L. Merin, A. Salunga, J. Hepworth, T. Cruthcer, D. O'Day, and, B. Pilon,. 2007. " Improving Diabetic Retinopathy Screening Ratios Using Telemedicine Based Digital Retinal Imaging Technology. Diabetes Care 30 (3): 574-8. (Pubitemid 46354336)
67. Thiagarajan, M., J. R. Evans, L. Smeeth, R. P. Wormald, and, A. E. Fletcher,. 2005. " Cause-Specific Visual Impairment and Mortality: Results from a Population-Based Study of Older People in the United Kingdom. Archives of Ophthalmology 123 (10): 1397-403.
68. Tikellis, G., L. D. Robman, A. Harper, J. J. McNeil, H. R. Taylor, and, C. A. McCarty,. 2000. " Methods for Detecting Age-Related Maculopathy: A Comparison between Photographic and Clinical Assessment. Clinical and Experimental Ophthalmology 28 (5): 367-72.
69. Tong, L., S. M. Saw, E. S. Chan, M. Yap, H. Y. Lee, Y. P. Kwang, and, D. Tan,. 2004. " Screening for Myopia and Refractive Errors Using LogMAR Visual Acuity by Optometrists and a Simplified Visual Acuity Chart by Nurses. Optometry and Vision Science 81 (9): 684-91. (Pubitemid 39223723)
70. Verteporfin in Photodynamic Therapy Study Group. 2001. " Verteporfin Therapy of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration: Two-Year Results of a Randomized Clinical Trial Including Lesions with Occult with No Classic Choroidal Neovascularization-Verteporfin in Photodynamic Therapy Report 2. American Journal of Ophthalmology 131: 541-60.
71. Vijan, S., T. P. Hofer, and, R. A. Hayward,. 2000. " Cost-Utility Analysis of Screening Intervals for Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus. Journal of the American Medical Association 283 (7): 889-96. (Pubitemid 30102129)
72. Weinstein, M. C., B. O'Brien, J. Hornberger, J. Jackson, M. Johannesson, C. McCabe, and, B. R. Luce,. 2003. " Principles of Good Practice for Decision Analytic Modeling in Health-Care Evaluation. Report of the ISPOR Task Force on Good Research Practices-Modeling Studies. Value in Health 6 (1): 9-17. (Pubitemid 36228345)
73. Weinstein, M. C., J. E. Siegel, M. R. Gold, K. M. S. vddfv, and, L. R. Russell,. 1996. " Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. Journal of the American Medical Association 276 (15): 1253-8. (Pubitemid 26337709)
74. Whited, J., S. Datta, L. Aiello, J. Cavallerano, P. Conlin, M. Horton, R. Poropatich, P. Challa, A. Darkins, and, S. Bursel,. 2005. " A Modeled Economic Analysis of a Digital Teleopthalmology System as Used by Three Federal Healthcare Agencies for Detecting Proliferative Diabetic Retinopathy. Telemedicine and e-Health 11 (6): 641-51. (Pubitemid 43227819)
75. Willan, A. R., and, D. Y. Lin,. 2001. " Incremental Net Benefit in Randomized Clinical Trials. Statistical Medicine 20 (11): 1563-74. (Pubitemid 32577128)
76. Williams, C., R. Lumb, I. Harvey, and, J. M. Sparrow,. 2000. " Screening for Refractive Errors with the Topcon PR2000 Pediatric Refractometer. Investigative Ophthalmology and Visual Science 41 (5): 1031-7. (Pubitemid 30187538)