Improving the value of screening for diabetic macular oedema using surrogate photographic markers
A decision model was developed to simulate the progression of patients with undiagnosed DMO. Sensitivity and specificity estimates derived from a perspective cohort were superimposed on top of this natural history model to estimate the costs and consequences (i.e. the number of appropriate/inappropriate ophthalmology referrals, patient years free from moderate vision loss, and quality adjusted life years) of adopting alternative screening strategies. The study also assessed the potential cost-effectiveness of using automated detection algorithms to predict the probability of DMO, and the cost-effectiveness of adding optical coherence tomography to the screening pathway for patients with suspected DMO.
Outcome and Translation
Many individuals currently referred to ophthalmology services from diabetic retinopathy screening programmes with suspected macular oedema are subsequently found not to require treatment. This results in high costs to the NHS and unnecessary anxiety for patients. The results of this study have helped to inform the incorporation of optical coherence tomography, to monitor patients with surrogate marker for macular oedema, within the screening programme.
External Collaborators: J Olson, P Sharp, K Goatman (Biomedical Physics, University of Aberdeen); G Prescott (Population Health, University of Aberdeen)
Olson, J., Sharp P, Goatman K, Prescott G, Scotland G, Fleming A, Philip A, Santiago C, Borooah S, Broadbent D, Chong V, Dodson P, Harding S, Leese G, Styles C, Swa K and Wharton H. (2012) Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema - a prospective, multi-centre, United Kingdom study. Final report submitted to the NIHR HTA Programme, NIHR HTA.
Olson, J., Sharp, P., Goatman, K., Prescott, G., Scotland, G., Fleming, A., Philip, S., Santiago, C., Borooah, S., Broadbent, D., Chong, V., Dodson, P., Harding, S., Leese, G., C., S., Swa, K. and Wharton, H. (2013) 'Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema: a prospective, multicentre, UK study', Health Technology Assessment, 17(51).
Prescott, G., Sharp, P., Goatman, K., Scotland, G., Fleming, A., Philip, S., Staff, R., Santiago, C., Borooah, S., Broadbent, D., Chong, V., Dodson, P., Harding, S., Leese, G., Megaw, R., Styles, C., Swa, K., Wharton, H. and Olson, J. (2014) 'Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study', British Journal of Ophthalmology, 98(8), 1042-1049.
Megaw, R., Booroah, S., Goatman, K., Scotland, G., Prescott, G., Sharp, P. and Olson, J. (2014) 'The use of OCT in retinal screening: results from the Improving Screening for Macular Oedema (ISMO) Study [poster]', Royal College of Ophthalmologists Annual Congress Birmingham, 20-22 May 2014.
Booroah, S., Megaw, R., Goatman, K., Scotland, G., Prescott, G., Sharp, P. and Olson, J. (2014) 'Multi-centre, prospective, observational, cohort study to assess the cost-effectiveness of English, Scottish and a hybrid grading schemes for diabetic macular oedema screening: improving screening for macular oedema (ISMO) study [poster]', Royal College of Ophthalmologists Annual Congress Birmingham, 20-22 May 2014.