Frequency of Retinal Screening Questioned
Annual eye screens for diabetic retinopathy provide only a marginal benefit over every-other-year tests for most groups of patients with type 2 diabetes, according to the cost-effectiveness model created by Sandeep Vigan M.D., M.S., and colleagues.
The team, affiliated with the Veterans Affairs quality enhancement research initiative, estimated that annual screens of patients with good glycemic control cost $80,000 to $256,000 for every quality-adjusted year of life gained, compared with every-other-year tests. These quality-adjusted life-years take into account the time spent blind and the extent to which blindness affects the quality of life.
Annual eye screens are most cost-effective when performed on patients with poor glycemic control and older diabetics, the authors reported. In these cases, annual screens cost an additional $60,000 per quality-adjusted life-year gained, compared with every-other-year tests.
In conducting the study, the authors created a model to simulate the progression of diabetic retinopathy and used the characteristics of diabetic patients older than 40 years old who had been part of a national government health survey. The authors assumed that ophthalmologists would conduct the screenings and used the Medicare reimbursement rates for these specialist-conducted screens.
Writing in the Feb. 16 issue of Journal of the American Medical Association, Vigan and colleagues noted that "optimal screening intervals have not been adequately evaluated, particularly with regard to variability in eye disease risk in those [diabetic patients] at low risk." Although annual screening for retinopathy is the safest, albeit most aggressive, approach, "if patients achieve good glycemic control and have normal results of baseline examinations, every second or third year screening is almost as good at preventing vision loss," the authors stated.
To view the article, go to jama.ama-assn.org/issues/v283n7/pdf/joc90293.pdf.