Tailored screenings for retinopathy in patients with diabetes could save millions of dollars

Fewer eye examinations may be needed for patients with type 1 diabetes, which could result in substantial long-term cost savings, according to a study.

Using retinal photographs from the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, researchers developed a rational screening frequency for retinopathy in patients with type 1 diabetes. Retinal examinations were performed every 6 months in the DCCT and every 4 years in the EDIC.

Over a 20-year period, researchers noted the practical, evidence-based schedule would result in 58% fewer examinations and substantial cost savings.

“Since digital photography costs approximately $200 and approximately 1 million patients have type 1 diabetes in the United States, the cost savings for eye screening with our data-driven approach, given the distribution of patients among the four states in the population, would be approximately $1 billion over 20 years, a 43.4% reduction as compared with routine annual screening,” the researchers wrote.

The researchers developed Markov models based on approximately 24,000 exams with seven-field fundus photography performed at intervals of 6 months to 48 months. The examinations of the type 1 diabetes cohort took place over the span of 30 years. Using these models, the researchers developed an evidence-based schedule of examinations for patients with type 1 diabetes.

For those with an average glycated hemoglobin value of 6%, researchers suggested an examination every 4 years if the patient has no retinopathy, every 3 years for mild retinopathy, every 6 months for moderate retinopathy and every 3 months for severe retinopathy. – by Robert Linnehan

Disclosure: Nathan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Source:

Nathan DM, et al. N Engl J Med. 2017;doi:10.1056/NEJMoa1612836.