Background
Methods
Study Setting and description
Model design
Model inputs
Parameter | Value | Sensitivity Analysis Range |
---|---|---|
1. DR transition probabilities | ||
No to Mild [27] | 0.07 | 0.01–0.10 |
Mild to Moderate [27] | 0.19 | 0.166–0.214 |
Moderate to VTDR [27] | 0.17 | 0.147–0.193 |
VTDR to Stable [28] | 0.90 | 0.881–0.919 |
Stable to Blindness [29] | 0.02 | 0.002–0.03 |
VTDR to Blindness [29] | 0.09 | 0.07–0.11 |
2. Utility | ||
No DR [30] | 0.94 | 0.83–1.05 |
Mild DR [30] | 0.87 | 0.73–1.01 |
Moderate DR [30] | 0.87 | 0.73–1.01 |
VTDR [30] | 0.83 | 0.74–0.92 |
Stable DR [31] | 0.85 | 0.72–0.78 |
Blindness [30] | 0.81 | 0.73–0.89 |
3. Disutility of DR [32] | 0.066 | - |
4. Mortality multipliers [26] | ||
Blindness | 2.34 | 2.22–2.46 |
Diabetes | 1.90 | 1.04–2.7 |
5. Sensitivity, % | ||
AI Screening screening [23] | 90.79 | 86.40-94.10 |
Ophthalmologist screening [24] | 96.00 | 94.79-97.21 |
6. Specificity, % | ||
AI screening [23] | 98.50 | 97.80-99.00 |
Ophthalmologist screening [24] | 94.67 | 94.57-97.43 |
7. Compliance of screening [33], % | 86.00 | - |
Cost Items | Cost ($) | Sensitivity Analysis Range |
---|---|---|
Health System costs | ||
1. Screening | ||
AI software | 1.447 | 0.723–2.17 |
Ophthalmologist salary | 3.213 | 1.606–4.819 |
Eye examination | 1.63 | 0.815–2.445 |
2. Follow-up visit | ||
Follow-up examination | 2.199 | 1.099–3.298 |
3. Laser treatment | 347.177 | 173.589–520.766 |
Societal costs | ||
1. Income loss | ||
Blindness (for the first year) [34] | 8,920 | 4,460–13,380 |
Blindness (in the following years) [34] | 3,600 | 1,800–5,400 |
Screening | 3.18 | 1.59–4.77 |
Treatment | 12.7 | 6.35–19.05 |
2. Transportation [35] | ||
Screening | 0.58 | 0.29–0.87 |
Follow-up visit | 2.30 | 1.15–3.45 |
Costs
Effectiveness
Cost-effectiveness analysis
Sensitivity analysis
Results
Cost-effectiveness analysis
Cost ($) | Incremental Cost (\(\Delta\)$) | Effectiveness (QALYs) | Incremental Effectiveness (\(\Delta\) QALY) | ICER (\(\Delta\)$/\(\Delta\) QALY) | |
---|---|---|---|---|---|
1. Health system perspective | |||||
No screening | 0 | - | 16.59 | - | - |
AI screening | 180.19 | 180.19 | 16.76 | 0.16 | 1,107.63 |
Ophthalmologist screening | 215.05 | 34.86 | 16.71 | -0.04 | Dominated |
2. Societal perspective | |||||
No screening | 0 | - | 16.59 | - | - |
AI screening | 1,683.23 | 1,683.23 | 16.76 | 0.16 | 10,347.12 |
Ophthalmologist screening | 1,775.48 | 92.25 | 16.71 | -0.04 | Dominated |