Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists

TitleCost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists
Publication TypeJournal Article
Year of Publication2017
Authorsvan Katwyk, S., Y. Jin, G. Trope, Y. Buys, L. Masucci, R. Wedge, J. Flanagan, M. Brent, S. El-Defrawy, H. Tu, and K. Thavorn
JournalValue in Health
Volume20
Pagination1034-1040
Keywordsadult, aged, Article, Canada, controlled study, cost benefit analysis, cost effectiveness analysis, cost of illness, cost utility analysis, Cost-Benefit Analysis, cost-utility analysis, diabetic retinopathy, diagnostic accuracy, disease burden, disease course, Disease Progression, economics, eye examination, general practitioner, health care policy, health care system, human, Humans, insurance, Insurance Coverage, laser coagulation, major clinical study, Markov chain, Markov Chains, mass screening, middle aged, National Health Programs, optometrist, Optometrists, patient selection, Prince Edward Island, priority journal, Probability, procedures, public health, public health insurance, publicly funded eye examination, quality adjusted life year, Quality-Adjusted Life Years, sensitivity analysis, time factor, Time Factors
Abstract

Background Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. Methods We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Results Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Conclusions Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)

DOI10.1016/j.jval.2017.04.015