Health economic evaluation of community-based diabetic retinopathy screening among type 2 diabetes mellitus patients in Shenzhen, China: a Markov model simulation study

ObjectiveTo conduct a health economic evaluation of a community-based screening strategy for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shenzhen, Guangdong Province, and to provide evidence for implementation of this screening strategy in primary healthcare facilities in the city. MethodsCommunity-based DR screening was conducted from August to December 2021 among 1200 T2DM patients recruited from 10 administrative districts in Shenzhen using a two-stage random sampling approach. A Markov model was constructed from a health care services perspective to conduct a cost-effectiveness analysis of the community-based DR screening strategy, with community-based DR screening as the intervention strategy and no screening as the control. Costs, effect sizes, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the results. ResultsOf the 1 097 participants finally included in the analysis, 266 (24.3%) were diagnosed with DR. Through 20 simulated cycles of systematic screening, the control (no screening) and intervention (screening) groups incurred costs of Chinese Yuan (CNY) 38 882.05 and CNY 41 920.75, respectively, and gained 17.13 and 17.42 quality adjusted life years (QALYs), respectively. The incremental cost-effectiveness ratio (ICER) was CNY 10 478.28/QALY. The net monetary benefits were CNY 218 071.06 and CNY 219 409.58 for the control and intervention groups, respectively, with a benefit-cost ratio of 5.23 for the screening strategy (indicating an indirect return of CNY 5.23 per CNY 1 invested). After 20 simulation cycles, the blindness rate was 21.0% (no screening) versus 10.1% (screening), with screening preventing approximately 120 cases of DR-related blindness in T2DM patients. Sensitivity analyses identified the health utility of blind patients and the annual cost of DME treatment as the most influential parameters. Probabilistic analysis showed good willingness-to-pay (WTP) among T2DM patients in Shenzhen, with screening being cost-effective at WTP thresholds > CNY 10 478.28/QALY. ConclusionsThe results demonstrate that the community-based DR screening strategy for T2DM patients in Shenzhen City is cost-effective and can be promoted in primary healthcare facilities in similar urban settings.