PMID- 29354716
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220311
IS  - 2397-3269 (Electronic)
IS  - 2397-3269 (Linking)
VI  - 2
IP  - 1
DP  - 2017
TI  - Diabetic retinopathy and the use of laser photocoagulation: is it cost-effective 
      to treat early?
PG  - e000021
LID - 10.1136/bmjophth-2016-000021 [doi]
LID - e000021
AB  - BACKGROUND/AIMS: The aim of the study was to explore whether it would be 
      cost-effective to apply panretinal photocoagulation (PRP) at the severe 
      non-proliferative diabetic retinopathy (NPDR) (early treatment) stage, compared 
      with waiting until high-risk proliferative diabetic retinopathy (HR-PDR) 
      characteristics (deferred treatment) developed. METHODS: A Markov model with a 
      30-year time horizon was developed, in which patients presenting with moderate 
      NPDR could progress through all stages of DR (severe 
      NPDR>early PDR>HR-PDR>severe PDR) to severe vision loss and blindness (and to 
      death). A National Health Service and personal social services perspective was 
      adopted. Transition probabilities were mainly derived from the Early Treatment 
      Diabetic Retinopathy Study. Health state utilities, costs and complications were 
      based on information from the literature, supplemented by expert opinion. Costs 
      and outcomes were discounted at 3.5%. Both deterministic and probabilistic 
      sensitivity analyses were conducted. RESULTS: Administering PRP at the severe 
      NPDR stage could be more effective and less costly than waiting until HR-PDR 
      developed. Sensitivity analyses gave similar results, with early treatment 
      continuing to dominate deferred treatment. The probabilistic sensitivity analysis 
      suggests that at willingness-to-pay threshold of  pound20- pound30 000 per quality-adjusted 
      life year, the probability of early treatment being cost-effective is 60%. 
      CONCLUSION: PRP administered at the severe NPDR stage is likely to be 
      cost-effective compared with delaying photocoagulation until HR-PDR develops. 
      However, given the limitations of the evidence, these results need to be 
      interpreted with caution. A trial of early versus deferred laser therapy is 
      needed to provide better data based on modern treatments.
FAU - Mistry, Hema
AU  - Mistry H
AD  - Warwick Medical School, University of Warwick, Coventry, UK.
FAU - Auguste, Peter
AU  - Auguste P
AD  - Warwick Medical School, University of Warwick, Coventry, UK.
FAU - Lois, Noemi
AU  - Lois N
AD  - Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
FAU - Waugh, Norman
AU  - Waugh N
AD  - Warwick Medical School, University of Warwick, Coventry, UK.
LA  - eng
PT  - Journal Article
DEP - 20170925
PL  - England
TA  - BMJ Open Ophthalmol
JT  - BMJ open ophthalmology
JID - 101714806
PMC - PMC5721644
OTO - NOTNLM
OT  - cost-effectiveness
OT  - diabetic retinopathy
OT  - laser photocoagulation
COIS- Competing interests: None declared.
EDAT- 2018/01/23 06:00
MHDA- 2018/01/23 06:01
PMCR- 2017/09/25
CRDT- 2018/01/23 06:00
PHST- 2016/07/11 00:00 [received]
PHST- 2017/07/20 00:00 [revised]
PHST- 2017/07/24 00:00 [accepted]
PHST- 2018/01/23 06:00 [entrez]
PHST- 2018/01/23 06:00 [pubmed]
PHST- 2018/01/23 06:01 [medline]
PHST- 2017/09/25 00:00 [pmc-release]
AID - bmjophth-2016-000021 [pii]
AID - 10.1136/bmjophth-2016-000021 [doi]
PST - epublish
SO  - BMJ Open Ophthalmol. 2017 Sep 25;2(1):e000021. doi: 10.1136/bmjophth-2016-000021. 
      eCollection 2017.