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Economic evaluation of combined population-based screening for multiple blindness-causing eye diseases in China: a cost-effectiveness analysis

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机构： [1]Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China [2]School of Medical Technology, Beijing Institute of Technology, Beijing, China [3]National Institutes of Health Data Science at Peking University, Beijing, China [4]Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia [5]Handan City Eye Hospital, Handan, China [6]School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China

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More than 90% of vision impairment is avoidable. However, in China, a routine screening programme is currently unavailable in primary health care. With the dearth of economic evidence on screening programmes for multiple blindness-causing eye diseases, delivery options, and screening frequencies, we aimed to evaluate the costs and benefits of a population-based screening programme for multiple eye diseases in China.We developed a decision-analytic Markov model for a cohort of individuals aged 50 years and older with a total of 30 1-year cycles. We calculated the cost-effectiveness and cost-utility of screening programmes for multiple major blindness-causing eye diseases in China, including age-related macular degeneration, glaucoma, diabetic retinopathy, cataracts, and pathological myopia, from a societal perspective (including direct and indirect costs). We analysed rural and urban settings separately by different screening delivery options (non-telemedicine [ie, face-to-face] screening, artificial intelligence [AI] telemedicine screening, and non-AI telemedicine screening) and frequencies. We calculated incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) in terms of the cost per blindness year avoided. One-way deterministic and simulated probabilistic sensitivity analyses were used to assess the robustness of the main outcomes.Compared with no screening, non-telemedicine combined screening of multiple eye diseases satisfied the criterion for a highly cost-effective health intervention, with an ICUR of US$2494 (95% CI 1130 to 2716) and an ICER of $12 487 (8773 to 18 791) in rural settings. In urban areas, the ICUR was $624 (395 to 907), and the ICER was $7251 (4238 to 13 501). Non-AI telemedicine screening could result in fewer costs and greater gains in health benefits (ICUR $2326 [1064 to 2538] and ICER $11 766 [8200 to 18 000] in rural settings; ICUR $581 [368 to 864] and ICER $6920 [3926 to 13 231] in urban settings). AI telemedicine screening dominated no screening in rural settings, and in urban settings the ICUR was $244 (-315 to 1073) and the ICER was $2567 (-4111 to 15 389). Sensitivity analyses showed all results to be robust. By further comparison, annual AI telemedicine screening was the most cost-effective strategy in both rural and urban areas.Combined screening of multiple eye diseases is cost-effective in both rural and urban China. AI coupled with teleophthalmology presents an opportunity to promote equity in eye health.National Natural Science Foundation of China.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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出版当年[2022]版：

大类 | 1 区

医学

小类 | 1 区公共卫生、环境卫生与职业卫生

最新[2023]版：

大类 | 1 区

医学

小类 | 1 区公共卫生、环境卫生与职业卫生

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出版当年[2021]版：

Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

最新[2023]版：

Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

影响因子： 20 最新[2023版] 26.5 最新五年平均 38.927 出版当年[2021版] 35.214 出版当年五年平均 26.763 出版前一年[2020版] 34.3 出版后一年[2022版]

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第一作者机构： [1]Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China [2]School of Medical Technology, Beijing Institute of Technology, Beijing, China [3]National Institutes of Health Data Science at Peking University, Beijing, China [*2]Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China

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通讯作者：

通讯机构： [1]Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China [2]School of Medical Technology, Beijing Institute of Technology, Beijing, China [3]National Institutes of Health Data Science at Peking University, Beijing, China [6]School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China [*1]Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China [*2]Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China [*3]School of Agricultural Economics and Rural Development, Renmin University of China, Beijing 100000, China

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