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

Hanruo Liu, PhD; Ruyue Li, MD; Yue Zhang, MD; Kaiwen Zhang, MD; Mayinuer Yusufu, PhD; Yanting Liu, PhD; Dapeng Mou, PhD; Xiaoniao Chen, PhD; Jiaxin Tian, PhD; Huiqi Li, ProfPhD; Sujie Fan, ProfMD; Jianjun Tang, PhD; Ningli Wang, ProfPhD

The Lancet Global Health (Mar 2023)

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

Hanruo Liu, PhD,
Ruyue Li, MD,
Yue Zhang, MD,
Kaiwen Zhang, MD,
Mayinuer Yusufu, PhD,
Yanting Liu, PhD,
Dapeng Mou, PhD,
Xiaoniao Chen, PhD,
Jiaxin Tian, PhD,
Huiqi Li, ProfPhD,
Sujie Fan, ProfMD,
Jianjun Tang, PhD,
Ningli Wang, ProfPhD

Affiliations

Hanruo Liu, PhD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; School of Medical Technology, Beijing Institute of Technology, Beijing, China; National Institutes of Health Data Science at Peking University, Beijing, China; Dr Hanruo Liu, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
Ruyue Li, MD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Yue Zhang, MD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Kaiwen Zhang, MD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Mayinuer Yusufu, PhD: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia
Yanting Liu, PhD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Dapeng Mou, PhD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Xiaoniao Chen, PhD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Jiaxin Tian, PhD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Huiqi Li, ProfPhD: School of Medical Technology, Beijing Institute of Technology, Beijing, China
Sujie Fan, ProfMD: Handan City Eye Hospital, Handan, China
Jianjun Tang, PhD: School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China; Dr Jianjun Tang, School of Agricultural Economics and Rural Development, Renmin University of China, Beijing 100000, China
Ningli Wang, ProfPhD: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; School of Medical Technology, Beijing Institute of Technology, Beijing, China; National Institutes of Health Data Science at Peking University, Beijing, China; Correspondence to: Prof Ningli Wang, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China

Journal volume & issue: Vol. 11, no. 3
pp. e456 – e465

Abstract

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Summary: Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: National Natural Science Foundation of China.

Published in The Lancet Global Health

ISSN: 2214-109X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: http://www.lancet.com/journals/langlo/issue/current

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