Can Retinal Screening Be Increased to 2 Years in T2DM?
Can Retinal Screening Be Increased to 2 Years in T2DM?
Objective In the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved.
Research Design and Methods We developed a model that simulates the progression of retinopathy in type 2 diabetic patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies.
Results The simulation model predicts that implementing a 2-year screening interval for type 2 diabetic patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ~25%.
Conclusions Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.
Diabetic retinopathy is a serious complication for people with diabetes that can lead to blindness or severe vision loss. Although retinopathy cannot be cured, its progression can be slowed or halted, and laser treatment can prevent visual loss if offered promptly at the proliferative stage. Diabetic digital retinal photography is an effective method of detecting the onset of treatable retinopathy. National Institute for Health and Clinical Excellence (NICE) guidelines in the U.K. currently recommend that people with diabetes are screened for retinopathy annually, or every 3–6 months for those patients who have developed beyond mild background retinopathy or who are at higher risk of progression. This also forms part of the National Screening Committee's policy of a national screening program for diabetes in the U.K.
The development of retinopathy may take decades, and the annual screening of all diabetic patients may therefore incur considerable cumulative health service cost and patient inconvenience that, for some, may be unjustified. With a significant increase in diabetes incidence forecast in the U.K., it is imperative that screening policies for diabetes complications are cost-effective and practicable. It is therefore prudent to ask whether it would be cost-effective and safe to screen diabetic patients for retinopathy less frequently, particularly in light of more recent evidence that suggests an overall decline in the rates at which people with diabetes are developing vision-threatening retinopathy.
We undertook a collaborative project with the Royal Devon and Exeter National Health Service (NHS) Foundation Trust (henceforth referred to simply as Royal Devon and Exeter), which carries out annual retinopathy screening for a population of ~20,000 patients across Devon. Using simulation modeling, we assessed the potential impact of implementing a 2-year retinopathy screening interval for those patients without retinopathy and who have type 2 diabetes. Diabetic retinopathy may progress more quickly in patients with type 1 diabetes, and although it has been shown that less frequent screening may be feasible for type 1 patients, we focus on the lower-risk type 2 diabetic patient group in this study. Previous studies have looked at the cost-effectiveness of longer screening intervals for diabetic retinopathy screening across all patients in a population, but we assessed an increased screening interval solely for those patients who have not yet been diagnosed with diabetic retinopathy. These patients represent ~40% of the type 1 and type 2 diabetic population screened by Royal Devon and Exeter, and reductions in the frequency with which they are screened could therefore lead to large potential cost and resource savings.
Abstract and Introduction
Abstract
Objective In the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved.
Research Design and Methods We developed a model that simulates the progression of retinopathy in type 2 diabetic patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies.
Results The simulation model predicts that implementing a 2-year screening interval for type 2 diabetic patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ~25%.
Conclusions Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.
Introduction
Diabetic retinopathy is a serious complication for people with diabetes that can lead to blindness or severe vision loss. Although retinopathy cannot be cured, its progression can be slowed or halted, and laser treatment can prevent visual loss if offered promptly at the proliferative stage. Diabetic digital retinal photography is an effective method of detecting the onset of treatable retinopathy. National Institute for Health and Clinical Excellence (NICE) guidelines in the U.K. currently recommend that people with diabetes are screened for retinopathy annually, or every 3–6 months for those patients who have developed beyond mild background retinopathy or who are at higher risk of progression. This also forms part of the National Screening Committee's policy of a national screening program for diabetes in the U.K.
The development of retinopathy may take decades, and the annual screening of all diabetic patients may therefore incur considerable cumulative health service cost and patient inconvenience that, for some, may be unjustified. With a significant increase in diabetes incidence forecast in the U.K., it is imperative that screening policies for diabetes complications are cost-effective and practicable. It is therefore prudent to ask whether it would be cost-effective and safe to screen diabetic patients for retinopathy less frequently, particularly in light of more recent evidence that suggests an overall decline in the rates at which people with diabetes are developing vision-threatening retinopathy.
We undertook a collaborative project with the Royal Devon and Exeter National Health Service (NHS) Foundation Trust (henceforth referred to simply as Royal Devon and Exeter), which carries out annual retinopathy screening for a population of ~20,000 patients across Devon. Using simulation modeling, we assessed the potential impact of implementing a 2-year retinopathy screening interval for those patients without retinopathy and who have type 2 diabetes. Diabetic retinopathy may progress more quickly in patients with type 1 diabetes, and although it has been shown that less frequent screening may be feasible for type 1 patients, we focus on the lower-risk type 2 diabetic patient group in this study. Previous studies have looked at the cost-effectiveness of longer screening intervals for diabetic retinopathy screening across all patients in a population, but we assessed an increased screening interval solely for those patients who have not yet been diagnosed with diabetic retinopathy. These patients represent ~40% of the type 1 and type 2 diabetic population screened by Royal Devon and Exeter, and reductions in the frequency with which they are screened could therefore lead to large potential cost and resource savings.
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