Surveillance of people with previously successfully treated diabetic macular oedema and proliferative diabetic retinopathy by trained ophthalmic graders: cost analysis from the EMERALD study

Mandy Maredza, Hema Mistry, Noemi Lois, Steve Aldington, Norman Waugh, EMERALD Study Group, Ahmed Saad, Daniela Vaideanu-Collins, Augusto Azuara-Blanco, Caroline Styles, Christine McNally, Andrew Jackson, Rachael Rice, Clare Bailey, Danny McAuley, David H Steel, Clair Barbour, Leontia Bell, Faruque D Ghanchi, Zeid Madanat, Geeta Menon, Manju Chandran, Sely Mathews, Mohammed Galal, Haralabos Eleftheriadis, Stefanos Efraimidis, Jonathan A Cook, Ariel Wang, William Sones, Lindsay Prior, Nachiketa Acharya, Samia Fatum, Janette Savage, Sobha Sivaprasad, Peter H Scanlon, Katerina Ivanova, Tariq M Aslam, Zaria Ali, Victor Chong, Mandy Maredza, Hema Mistry, Noemi Lois, Steve Aldington, Norman Waugh, EMERALD Study Group, Ahmed Saad, Daniela Vaideanu-Collins, Augusto Azuara-Blanco, Caroline Styles, Christine McNally, Andrew Jackson, Rachael Rice, Clare Bailey, Danny McAuley, David H Steel, Clair Barbour, Leontia Bell, Faruque D Ghanchi, Zeid Madanat, Geeta Menon, Manju Chandran, Sely Mathews, Mohammed Galal, Haralabos Eleftheriadis, Stefanos Efraimidis, Jonathan A Cook, Ariel Wang, William Sones, Lindsay Prior, Nachiketa Acharya, Samia Fatum, Janette Savage, Sobha Sivaprasad, Peter H Scanlon, Katerina Ivanova, Tariq M Aslam, Zaria Ali, Victor Chong

Abstract

Background/aims: Surveillance of people with previously successfully treated diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR) adds pressure on ophthalmology services. This study evaluated a new surveillance pathway entailing multimodal imaging reviewed by trained ophthalmic graders and compared it with the current standard care (face-to-face evaluation by an ophthalmologist).

Methods: Cost analysis of the new ophthalmic grader pathway, compared with the standard of care, from the perspective of the UK National Health Service, based on evidence from the Effectiveness of Multimodal imaging for the Evaluation of Retinal oedema And new vesseLs in Diabetic retinopathy study. Resource use data were prospectively obtained including times to undertake each procedure. Effectiveness was assessed in terms of sensitivity and specificity of referral decisions in the grader pathway. Costs (SDs) were analysed per 100 patients separately for DMO and PDR at 2018/2019 costs.

Results: For DMO, where sensitivity was very high (97%), the cost difference (savings) for the grader's pathway would be £1390 per 100 patients. For PDR, the cost would be reduced by £461 for seven-field Early Treatment for Diabetic Retinopathy Study (ETDRS) images and by £1889 for ultrawide field images, per 100 patients. Ultrawide images required less time to be obtained and read than seven-field ETDRS. The real savings would be in ophthalmologist time, which could be then redirected to the evaluation of people at high risk of visual loss.

Conclusions: Surveillance of people with previously successfully treated DMO and PDR by trained ophthalmic graders can achieve satisfactory results and release ophthalmologist time.

Trial registration numbers: NCT03490318, ISRCTN10856638.

Keywords: diagnostic tests/investigation; imaging; macula; public health; retina.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

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Source: PubMed

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