Combined Discrete-event Simulation and Ant Colony Optimisation Approach for Selecting Optimal Screening Policies for Diabetic Retinopathy

Brailsford, Sally C.; Gutjahr, Walter J.; Rauner, Marion S.; Zeppelzauer, Wolfgang

doi:10.1007/s10287-006-0008-x

Cited by 43 publications

(43 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At current NICE thresholds of £20,000 to £30,000 per QALY gained, annual screening would not be considered cost-effective. Our results are similar to those by Brailsford et al, 88 which concluded that a 30-month screening interval was the most cost-effective option.…”

Section: Resultssupporting

confidence: 92%

“…46 The review only identified three studies, one performed in the USA and two in the UK. The UK study by Brailsford et al 88 found similar results to the US study. The study, which also used a decision analytic model to assess the cost-effectiveness of DR screening in both type 1 and type 2 diabetes patients, found that a 30-month screening interval was the most cost-effective option.…”

Section: Existing Researchsupporting

confidence: 57%

“…A UK study by Brailsford et al 47 also found similar results to that of Vijan et al 27 The study, which again used decision modelling techniques to assess the cost-effectiveness of screening intervals in diabetes patients (both types 1 and 2), found that a 30-month screening interval was the most cost-effective option. However, in contrast to these two studies, another UK study by Davies et al 48 found that screening diabetic patients less than once a year would not be any more cost-effective than every year.…”

Section: Introductionsupporting

confidence: 55%

See 2 more Smart Citations

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

110

167

View full text Add to dashboard Cite

BackgroundThe English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.ObjectivesTo determine whether personalised screening intervals are cost-effective.DesignRisk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium–low, medium–high or high risk). The risk factor models were validated in other populations.SettingGloucestershire, Nottinghamshire, South London and East Anglia (all UK).ParticipantsPeople with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.Main outcome measuresPersonalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.ResultsData were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43 –48% while screening high-risk groups every 2 years was cost-effective with a probability of 55–59%.ConclusionsThe study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading.Study registrationIntegrated Research Application System project number 118959.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Resultssupporting

confidence: 92%

Section: Existing Researchsupporting

confidence: 57%

Section: Introductionsupporting

confidence: 55%

See 1 more Smart Citation

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

110

167

View full text Add to dashboard Cite

show abstract

“…This algorithm was improved by Branke and Guntsch and, very recently, by Balaprakash et al [7], resulting in a state-of-the-art algorithm for the PTSP. Other applications of ACO include vehicle routing problems with uncertain demands [13] and the selection of optimal screening policies for diabetic retinopathy [28]; the latter approach builds on the S-ACO algorithm proposed earlier by Gutjahr [85].…”

Section: Stochastic Optimization Problemsmentioning

confidence: 99%

Ant Colony Optimization: Overview and Recent Advances

Dorigo

Stützle

2018

International Series in Operations Research &Amp; Management Science

503

261

View full text Add to dashboard Cite

“…Simulation modelling has been applied to various healthcare areas such as a vascular surgery [29], accident and emergency [30], intermediate care [31] and the evaluation of screening programmes [40][41]. Shukla et al [50] have used modelling for the accessibility based radiotherapy facility location for cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Pathway variation analysis (PVA): Modelling and simulations

Shukla

Lahiri

Ceglarek

2015

Operations Research for Health Care

View full text Add to dashboard Cite

Maintaining a care pathway within a hospital to provide complex care to patients is associated with challenges related to variations from the pathway. This occurs due to ineffective decision-making processes, unclear process steps, the interactions, conflicting performance measures for speciality units, and the availability of resources. These variations from the care pathway or standard care delivery processes lead to longer patient waiting times and lower patient throughput. Traditional approaches to improve the pathway focus primarily on reducing variations within the care pathway such as bottlenecks or throughput within the pathway rather than examining variations from the care pathway. In this study, we propose a novel methodology, called pathway variation analysis (PVA), to identify, simulate and analyse variations from the patient care pathways. PVA method includes patient ward level journey dataset and qualitative staff interviews to simulate patient variations. The proposed methodology had been applied to the stroke care services of a hospital, which increased their key performance from 73% to 84.97%. A PVA methodology is proposed which simulated patient diversions from the care pathway by modelling hospital operational parameters, assessing the accuracy of clinical decisions and performance measures of speciality units involved. The proposed methodology can be applied to other care pathways settings to reduce patient diversion from the care pathway.

show abstract

Combined Discrete-event Simulation and Ant Colony Optimisation Approach for Selecting Optimal Screening Policies for Diabetic Retinopathy

Abstract: Screening for diabetic retinopathy, Discrete event simulation, Ant colony optimisation, Cost-effectiveness analysis, Decision-support system,

Cited by 43 publications

References 31 publications

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Ant Colony Optimization: Overview and Recent Advances

Pathway variation analysis (PVA): Modelling and simulations

Contact Info

Product

Resources

About