Two-level Modeling for Economic Evaluation of Diabetic Retinopathy Telescreening

摘要

Diabetic retinopathy (DR) is the leading cause of acquired blindness among working-age adults. Although the risk of vision loss can be reduced significantly through early diagnosis of DR, fewer than half of diabetic patients follow eye screening guidelines. This paper demonstrates a two-level modeling approach to compare a DR telescreening (DRTS) program providing screening at the primary-care setting to the traditional ophthalmologist-based screening strategy in a chiefly Hispanic community. The goal is to determine whether DRTS is at least as effective and cost-effective as the traditional screening strategy from both the societal and service perpectives. Evaluation and comparison of the different strategies are done at the societal level using a Markov simulation that embeds the screening model in a natural disease progression model and simulates the effect and costs of DR screening on target cohorts. Evaluation is also done using a service level simulation to assess the different impact of DRTS and the traditional screening strategies on metrics such as patients' compliance with screening and costs of service provision. The outcome simulation coupled with service modeling allows identification of changes at the service level that would achieve a cost-effective DR screening strategy in the long-term.