Susana Ruiz Bilbao, Ariadna Mas Casals, Sandra Gómez Sánchez, Pablo Díaz-Aljaro, Thiago Carnaval, Antoni Sabala, Oriol Estrada Cuxart, Sebastián Videla
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引用次数: 0
Abstract
Background: Diabetic retinopathy (DR) is a leading cause of preventable blindness among people with type 2 diabetes mellitus (T2DM). Early detection is essential to prevent vision-threatening complications. This study evaluated the long-term cost-effectiveness of CODMAP (Ophthalmologic Screening for Diabetes Mellitus in Primary Care (Cribado Oftalmológico en Diabetes Mellitus en Atención Primaria)), an optimised screening programme combining two-field non-mydriatic fundus photography (NMFP) and optical coherence tomography versus conventional single-field NMFP in a public healthcare setting.
Methods: A Markov model simulated DR progression over 50 years in a cohort of 7729 patients with T2DM. Eight health states reflected DR severity, with state-specific costs and quality-adjusted life years (QALYs) accrued annually. Analyses took the perspective of the Spanish National Health Service, applying a 3% annual discount rate. Incremental cost-effectiveness ratios, calculated as a ratio of means (ICERsROM), and net monetary benefits (NMBs) were estimated through 10 000 Monte Carlo simulations, at a €30 000 willingness-to-pay threshold. Deterministic and probabilistic sensitivity analyses, scenario analyses and bootstrap validation were performed.
Results: CODMAP accrued higher costs (€206.4 million vs €205.1 million) but more QALYs (128 691.7 vs 118 013.8), resulting in an ICERROM of €124.25/QALY. The probability of cost-effectiveness at €30 000/QALY was 74.3%, remaining stable in scenario analyses (75.7%-78.8%). Mean incremental NMB in the base case was €319.0 million. Cost and QALY variations were the main drivers of uncertainty.
Conclusion: CODMAP offers greater long-term health gains at a favourable incremental cost per QALY in the Spanish context. However, the non-definitive probability of cost-effectiveness warrants cautious policy consideration, with attention to local infrastructure, implementation capacity and cost structures.
背景：糖尿病视网膜病变（DR）是2型糖尿病（T2DM）患者可预防失明的主要原因。早期发现对于预防威胁视力的并发症至关重要。本研究评估了CODMAP（初级保健眼科糖尿病筛查（Cribado Oftalmológico en Diabetes Mellitus en Atención Primaria））的长期成本效益，这是一种优化的筛查方案，结合了两场非散眼底摄影（NMFP）和光学相干断层扫描，而不是在公共医疗机构中采用传统的单场NMFP。方法：一个Markov模型模拟了7729例T2DM患者50年的DR进展。8个健康状态反映了DR的严重程度，具体的状态成本和每年累积的质量调整生命年（QALYs）。分析采用西班牙国家医疗服务体系的视角，采用3%的年贴现率。增量成本效益比，计算为均值比（ICERsROM）和净货币效益（nmb），通过1万次蒙特卡罗模拟估算，支付意愿阈值为3万欧元。进行了确定性和概率敏感性分析、情景分析和自举验证。结果：CODMAP累积了更高的成本（2.064亿欧元对2.051亿欧元），但更多的QALY（128 691.7欧元对118 013.8欧元），导致ICERROM为124.25欧元/QALY。成本效益达到3万欧元/QALY的概率为74.3%，在情景分析中保持稳定（75.7%-78.8%）。在基本情况下，平均增量NMB为3.19亿欧元。成本和质量变化是不确定性的主要驱动因素。结论：在西班牙的情况下，CODMAP以有利的每QALY增量成本提供了更大的长期健康收益。然而，成本效益的不确定可能性值得谨慎的政策考虑，并注意到当地的基础设施、执行能力和成本结构。
期刊介绍：
The British Journal of Ophthalmology (BJO) is an international peer-reviewed journal for ophthalmologists and visual science specialists. BJO publishes clinical investigations, clinical observations, and clinically relevant laboratory investigations related to ophthalmology. It also provides major reviews and also publishes manuscripts covering regional issues in a global context.
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