Surveillance of people with previously successfully treated diabetic macular oedema and proliferative diabetic retinopathy by trained ophthalmic graders: cost analysis from the EMERALD study. Issue 11 (3rd June 2021)

• Record Type: Journal Article
• Authors: Maredza, Mandy; Mistry, Hema; Lois, Noemi; Aldington, Steve; Waugh, Norman
• Other Names: author non-byline.; Saad Ahmed author non-byline.; Vaideanu-Collins Daniela author non-byline.; Azuara-Blanco Augusto author non-byline.; Styles Caroline author non-byline.; McNally Christine author non-byline.; Jackson Andrew author non-byline.; Rice Rachael author non-byline.; Bailey Clare author non-byline.; McAuley Danny author non-byline.; Steel David H author non-byline.; Barbour Clair author non-byline.; Bell Leontia author non-byline.; Ghanchi Faruque D author non-byline.; Madanat Zeid author non-byline.; Menon Geeta author non-byline.; Chandran Manju author non-byline.; Mathews Sely author non-byline.; Galal Mohammed author non-byline.; Eleftheriadis Haralabos author non-byline.; Efraimidis Stefanos author non-byline.; Cook Jonathan A author non-byline.; Wang Ariel author non-byline.; Sones William author non-byline.; Prior Lindsay author non-byline.; Acharya Nachiketa author non-byline.; Fatum Samia author non-byline.; Savage Janette author non-byline.; Sivaprasad Sobha author non-byline.; Scanlon Peter H author non-byline.; Ivanova Katerina author non-byline.; Aslam Tariq M author non-byline.; Ali Zaria author non-byline.; Chong Victor author non-byline.;
• Is Part Of: British journal of ophthalmology. Volume 106:Issue 11(2022)
• Page Start: 1549
• Page End: 1554
• Publication Date: 2021-06-03
• Subjects: imaging -- macula -- retina -- diagnostic tests/investigation -- public health; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2021-318816
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/aims: Surveillance of people with previously successfully treated diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR) adds pressure on ophthalmology services. This study evaluated a new surveillance pathway entailing multimodal imaging reviewed by trained ophthalmic graders and compared it with the current standard care (face-to-face evaluation by an ophthalmologist). Methods: Cost analysis of the new ophthalmic grader pathway, compared with the standard of care, from the perspective of the UK National Health Service, based on evidence from the Effectiveness of Multimodal imaging for the Evaluation of Retinal oedema And new vesseLs in Diabetic retinopathy study. Resource use data were prospectively obtained including times to undertake each procedure. Effectiveness was assessed in terms of sensitivity and specificity of referral decisions in the grader pathway. Costs (SDs) were analysed per 100 patients separately for DMO and PDR at 2018/2019 costs. Results: For DMO, where sensitivity was very high (97%), the cost difference (savings) for the grader's pathway would be £1390 per 100 patients. For PDR, the cost would be reduced by £461 for seven-field Early Treatment for Diabetic Retinopathy Study (ETDRS) images and by £1889 for ultrawide field images, per 100 patients. Ultrawide images required less time to be obtained and read than seven-field ETDRS. The real savings would be in ophthalmologist time, which could be then redirected to the evaluation of people at high risk of visual loss. Conclusions: Surveillance of people with previously successfully treated DMO and PDR by trained ophthalmic graders can achieve satisfactory results and release ophthalmologist time. Trial registration numbers: NCT03490318, ISRCTN10856638 .