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Li H, Li G, Li N, Liu C, Yuan Z, Gao Q, Hao S, Fan S, Yang J. Cost-effectiveness analysis of artificial intelligence-based diabetic retinopathy screening in rural China based on the Markov model. PLoS One 2023; 18:e0291390. [PMID: 37971984 PMCID: PMC10653408 DOI: 10.1371/journal.pone.0291390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023] Open
Abstract
This study assessed the cost-effectiveness of different diabetic retinopathy (DR) screening strategies in rural regions in China by using a Markov model to make health economic evaluations. In this study, we determined the structure of a Markov model according to the research objectives, which required parameters collected through field investigation and literature retrieval. After perfecting the model with parameters and assumptions, we developed a Markov decision analytic model according to the natural history of DR in TreeAge Pro 2011. For this model, we performed Markov cohort and cost-effectiveness analyses to simulate the probabilistic distributions of different developments in DR and the cumulative cost-effectiveness of artificial intelligence (AI)-based screening and ophthalmologist screening for DR in the rural population with diabetes mellitus (DM) in China. Additionally, a model-based health economic evaluation was performed by using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios. Last, one-way and probabilistic sensitivity analyses were performed to assess the stability of the results. From the perspective of the health system, compared with no screening, AI-based screening cost more (the incremental cost was 37,257.76 RMB (approximately 5,211.31 US dollars)), but the effect was better (the incremental utility was 0.33). Compared with AI-based screening, the cost of ophthalmologist screening was higher (the incremental cost was 14,886.76 RMB (approximately 2,070.19 US dollars)), and the effect was worse (the incremental utility was -0.31). Compared with no screening, the incremental cost-effectiveness ratio (ICER) of AI-based DR screening was 112,146.99 RMB (15,595.47 US dollars)/QALY, which was less than the threshold for the ICER (< 3 times the per capita gross domestic product (GDP), 217,341.00 RMB (30,224.03 US dollars)). Therefore, AI-based screening was cost-effective, which meant that the increased cost for each additional quality-adjusted life year was merited. Compared with no screening and ophthalmologist screening for DR, AI-based screening was the most cost-effective, which not only saved costs but also improved the quality of life of diabetes patients. Popularizing AI-based DR screening strategies in rural areas would be economically effective and feasible and can provide a scientific basis for the further formulation of early screening programs for diabetic retinopathy.
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Affiliation(s)
- Huilin Li
- Department of Ophthalmology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, China
| | - Guanyan Li
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
- Shenzhen Longgang Otorhinolaryngology Hospital, Shenzhen, 518100, China
| | - Na Li
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Changyan Liu
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Ziyou Yuan
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Qingyue Gao
- Postgraduate Department, Changzhi Medical College, Changzhi, 046000, China
| | - Shaofeng Hao
- Department of Ophthalmology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, China
| | - Shengfu Fan
- Department of Foreign Languages, Changzhi Medical College, Changzhi, 046000, China
| | - Jianzhou Yang
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, 046000, China
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol. Pilot Feasibility Stud 2023; 9:158. [PMID: 37689724 PMCID: PMC10492373 DOI: 10.1186/s40814-023-01372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. METHODS We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50-150 patients and 5-10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. DISCUSSION This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
- VITAM, Centre for Research On Sustainable Health, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- School of Psychology, University of Ottawa, Ottawa, Canada.
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Johnson KM, Sadatsafavi M, Adibi A, Lynd L, Harrison M, Tavakoli H, Sin DD, Bryan S. Cost Effectiveness of Case Detection Strategies for the Early Detection of COPD. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:203-215. [PMID: 33135094 DOI: 10.1007/s40258-020-00616-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost effectiveness of primary care-based case detection strategies for COPD. METHODS A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost effectiveness of 16 case detection strategies. In these strategies, eligible patients (based on age, smoking history, or symptoms) received the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3- or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients received treatment for smoking cessation and guideline-based inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are in 2019 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis. RESULTS Compared to no case detection, all 16 case detection scenarios had an incremental cost-effectiveness ratio (ICER) below $50,000/QALY gained. In the most efficient scenario, all patients aged ≥ 40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $287 and incremental effectiveness of 0.015 QALYs per eligible patient over the 20-year time horizon, resulting in an ICER of $19,632/QALY compared to no case detection. Results were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. CONCLUSIONS Primary care-based case detection programs for COPD are likely to be cost effective if there is adherence to best-practice recommendations for treatment, which can alleviate symptoms in newly diagnosed patients.
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Affiliation(s)
- Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, Canada
- Institute for Heart and Lung Health, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Mark Harrison
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation (The James Hogg Research Centre), St. Paul's Hospital, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Siegel KR, Ali MK, Zhou X, Ng BP, Jawanda S, Proia K, Zhang X, Gregg EW, Albright AL, Zhang P. Cost-effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008? Diabetes Care 2020; 43:1557-1592. [PMID: 33534729 DOI: 10.2337/dci20-0017] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between June 2008 and July 2017. We also incorporated studies from a previous CE review from the period 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: cost-saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001-$50,000 per LYG or QALY), marginally cost-effective ($50,001-$100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars. RESULTS Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: In the cost-saving category are 1) ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management, 2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy, 3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers, 4) telemedicine for diabetic retinopathy screening compared with office screening, and 5) bariatric surgery compared with no surgery for individuals with type 2 diabetes (T2D) and obesity (BMI ≥30 kg/m2). In the very cost-effective category are 1) intensive glycemic management (targeting A1C <7%) compared with conventional glycemic management (targeting an A1C level of 8-10%) for individuals with newly diagnosed T2D, 2) multicomponent interventions (involving behavior change/education and pharmacological therapy targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, nephropathy/retinopathy, secondary prevention of cardiovascular disease with aspirin) compared with usual care, 3) statin therapy compared with no statin therapy for individuals with T2D and history of cardiovascular disease, 4) diabetes self-management education and support compared with usual care, 5) T2D screening every 3 years starting at age 45 years compared with no screening, 6) integrated, patient-centered care compared with usual care, 7) smoking cessation compared with no smoking cessation, 8) daily aspirin use as primary prevention for cardiovascular complications compared with usual care, 9) self-monitoring of blood glucose three times per day compared with once per day among those using insulin, 10) intensive glycemic management compared with conventional insulin therapy for T2D among adults aged ≥50 years, and 11) collaborative care for depression compared with usual care. CONCLUSIONS Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mohammed K Ali
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,Hubert Department of Global Health and Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Boon Peng Ng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL
| | - Shawn Jawanda
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Krista Proia
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xuanping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Ho R, Song LD, Choi JA, Jee D. The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea. PLoS One 2018; 13:e0206690. [PMID: 30379971 PMCID: PMC6209376 DOI: 10.1371/journal.pone.0206690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022] Open
Abstract
Background Interventions that can facilitate early diagnosis of age-related macular degeneration (AMD) will facilitate early treatment and improve clinical outcomes but there has been concerns about additional medical costs to the health care system. An examination through a retina fundus photography by a non-specialist has been suggested as a potential cost-effective alternative to a direct examination by a specialist, but limited scientific data exists on the cost-effectiveness of screening strategies for AMD. Our objective is to conduct an economic evaluation of various population-wide screening strategies for AMD among the South Korean population. Methods and findings Using a Markov cohort model, we evaluated the cost-effectiveness of four AMD screening strategies (opportunistic examination, opportunistic treatment, systematic photography, and systematic examination) in comparison with status quo (no screening) for South Korean adults. We projected a life time horizon to study a hypothetical cohort of 100,00 persons of age 40 with and without AMD at baseline. The outcome measures were quality-adjusted life-years (QALYs) gained, cost from the societal perspective, and the incremental cost-effectiveness ratio (ICER) of each strategy. Interventions were evaluated at a willingness-to-pay (WTP) threshold of 30,000,000 KRW ($27,538) per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to address the model uncertainty. Opportunistic examination was strongly dominated because it generated fewer expected QALYs but incurred greater expected cost than the other screening strategies. The mean lifetime expected costs were 289,013 KRW, 363,692 KRW, 9,351,964 KRW, and 12,309,783 KRW, and the mean QALYs gained were 37.73, 37.75, 40.47, 40.68, for no screening, opportunistic treatment, systematic photography, and systematic examination, respectively. The results were most sensitive to the utility weight of mild AMD, the probability of complication from treatment, the cost of being in mild AMD, and the probability of recovery from complication. After eliminating the two weakly dominated strategies, systematic photography was cost-effective at the ICER of 3,310,448 KRW per QALY in comparison to status quo. Conclusions Under the WTP threshold of 30,000,000 KRW per QALY, systematic photography is cost-effective for screening AMD in South Korean adults. Systematic examination by ophthalmologists generates more expected QALY and cost compared to systematic photography.
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Affiliation(s)
- Ra Ho
- Department of Ophthalmology and Visual Science, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea
| | - Lina D. Song
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America
| | - Jin A. Choi
- Department of Ophthalmology and Visual Science, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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Lee EY, Cui K, Trope GE, Buys YM, Chan CH, Thavorn K, Jin YP. Eye care utilisation in Newfoundland and Labrador: access barriers and vision health outcomes. Can J Ophthalmol 2018; 53:342-348. [PMID: 30119787 DOI: 10.1016/j.jcjo.2017.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Our prior study revealed significantly lower use of eye care providers in Newfoundland and Labrador (NFLD). This study reports factors associated with this low use and related vision health outcomes. DESIGN Cross-sectional survey. PARTICIPANTS A total of 14 925 Caucasian respondents to the Canadian Community Health Survey - Healthy Aging 2008/2009 aged ≥65 years. METHODS Univariate and multivariate analyses were performed using self-reported survey data. RESULTS NFLD, along with 3 other provinces, does not insure seniors for routine eye examinations. Among seniors without self-reported glaucoma, cataracts, and diabetes, the use of eye care providers in NFLD (36.3%) is the lowest compared with provinces with (50.7%, p < 0.05) and without (42.2%, p > 0.05) government-insured eye examinations. Among seniors with known eye disease insured for eye care in all provinces, eye care utilisation in NFLD (63.1%) is still the lowest across all provinces (69.4%-71.3%, p > 0.05). Compared with the national average, NFLD seniors have significantly higher proportions of low income (61.7% vs 47.4%), no postsecondary education (53.6% vs 42.2%), and rural residency (40.6% vs 18.9%). These factors are all associated with low levels of eye care utilisation. Compared with insured provinces, NFLD has a significantly lower prevalence of self-reported cataracts (16.7% vs 23.1) and glaucoma (3.8% vs 7.0%), and a slightly higher prevalence of presenting visual impairment (4.0% vs 3.5%). CONCLUSIONS Lack of government insurance, low socioeconomic status, and living in nonurbanised areas all contribute to the underutilisation of eye care providers in NFLD. This underutilisation appears to be associated with reduced detection of eye diseases.
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Affiliation(s)
| | - Kangping Cui
- Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Graham E Trope
- Faculty of Medicine, University of Toronto, Toronto, Ont.; Toronto Western Research Institute/University Health Network, Toronto, Ont
| | - Yvonne M Buys
- Faculty of Medicine, University of Toronto, Toronto, Ont.; Toronto Western Research Institute/University Health Network, Toronto, Ont
| | - Christina H Chan
- Toronto Western Research Institute/University Health Network, Toronto, Ont
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ont.; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont.; Institute for Clinical and Evaluative Sciences (ICES@uOttawa), Ottawa, Ont
| | - Ya-Ping Jin
- Faculty of Medicine, University of Toronto, Toronto, Ont.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont..
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Iragorri N, Spackman E. Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis. Public Health Rev 2018; 39:17. [PMID: 30009081 PMCID: PMC6043991 DOI: 10.1186/s40985-018-0093-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/04/2018] [Indexed: 12/29/2022] Open
Abstract
Background Screening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools. Objective This review seeks to evaluate the latest cost-effectiveness analyses on screening tools to identify the current challenges encountered and potential methods to overcome them. Methods A systematic literature search of EMBASE and MEDLINE identified cost-effectiveness analyses of screening tools published in 2017. Data extracted included the population, disease, screening tools, comparators, perspective, time horizon, discounting, and outcomes. Challenges and methodological suggestions were narratively synthesized. Results Four key categories were identified: screening pathways, pre-symptomatic disease, treatment outcomes, and non-health benefits. Not all studies included treatment outcomes; 15 studies (22%) did not include treatment following diagnosis. Quality-adjusted life years were used by 35 (51.4%) as the main outcome. Studies that undertook a societal perspective did not report non-health benefits and costs consistently. Two important challenges identified were (i) estimating the sojourn time, i.e., the time between when a patient can be identified by screening tests and when they would have been identified due to symptoms, and (ii) estimating the treatment effect and progression rates of patients identified early. Conclusions To capture all important costs and outcomes of a screening tool, screening pathways should be modeled including patient treatment. Also, false positive and false negative patients are likely to have important costs and consequences and should be included in the analysis. As these patients are difficult to identify in regular data sources, common treatment patterns should be used to determine how these patients are likely to be treated. It is important that assumptions are clearly indicated and that the consequences of these assumptions are tested in sensitivity analyses, particularly the assumptions of independence of consecutive tests and the level of patient and provider compliance to guidelines and sojourn times. As data is rarely available regarding the progression of undiagnosed patients, extrapolation from diagnosed patients may be necessary.
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Affiliation(s)
- Nicolas Iragorri
- 1Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada.,2Health Technology Assessment Unit, University of Calgary, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Eldon Spackman
- 1Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada.,2Health Technology Assessment Unit, University of Calgary, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
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