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

• Published in: Value in health Vol. 20; no. 8; pp. 1034 - 1040
• Main Authors: van Katwyk, Sasha, MSc, Jin, Ya-ping, MD, PhD, Trope, Graham E., MB, PhD, FRCSC, Buys, Yvonne, MD, FRCSC, Masucci, Lisa, MSc, Wedge, Richard, MD, Flanagan, John, OD, PhD, Brent, Michael H., MD, FRCSC, El-Defrawy, Sherif, MD, PhD, FRCSC, Tu, Hong Anh, PhD, Thavorn, Kednapa, MPharm, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017; Elsevier Science Ltd
• Subjects: Aged; Blindness; Canada; Cost analysis; Cost of Illness; Cost-Benefit Analysis; cost-utility analysis; Diabetes; Diabetes mellitus; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - economics; Disease Progression; Eye; Eye examinations; Health care expenditures; Health insurance; Humans; Insurance coverage; Insurance Coverage - economics; Internal Medicine; Markov Chains; Mass Screening - economics; Mass Screening - methods; Medical screening; Middle Aged; National Health Programs - economics; optometrist; Optometrists - economics; Optometry; Prince Edward Island; Probability; Public health; publicly funded eye examination; Quality adjusted life years; Retinopathy; Sensitivity analysis; Time Factors; Utility functions; Visual impairment; optometrist; publicly funded eye examination; cost-utility analysis; diabetic retinopathy
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.04.015

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.