Health utility values associated with diabetic retinopathy

Lloyd, Adam; Nafees, Beenish; Gavriel, Sonia; Rousculp, Matthew D.; Boye, Kristina S.; Ahmad, Amier

doi:10.1111/j.1464-5491.2008.02430.x

Cited by 67 publications

(80 citation statements)

References 26 publications

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“…In that sense, our results agree with previous observations by other investigators using the EQ-5D-3L (Langelaan et al 2007;van Nispen et al 2009) and other health utilities instruments (Crewe et al 2011;Briesen et al 2014). In contrast with our results, a study by Lloyd and colleagues found inconsistent associations of utilities with visual acuity in patients with diabetic retinopathy (Lloyd et al 2008). Lloyd obtained lower scores for patients with acuity 6/12 to 6/18 than for patients with acuity 6/24 to 6/36.…”

Section: Discussioncontrasting

confidence: 56%

Visual and health outcomes, measured with the activity inventory and the EQ‐5D, in visual impairment

Macedo

Ramos

Hernández-Moreno

et al. 2017

Acta Ophthalmologica

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PurposeGeneric instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition-specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ-5D-3L and the Activity-inventory (AI). MethodsParticipants were recruited in different hospitals during the PCVIP-study. A total of 134 patients with acuity 0.30 logMAR or less in the better eye were interviewed. The AI includes 46 goals split between three objectives: social functioning, recreation and daily living, was used to measure visual ability. The EQ-5D consists of five questions covering one domain each and was used to provide a measure of health states. Responses to each domain were combined to produce a single individual index.ResultsThe AI and the EQ-5D-3L showed enough discriminatory power between VI levels (p<.001) and their results were strongly correlated r(134)=.825, (p<.001). Explanatory factors for visual ability were level of VI in better eye, age and gender, R 2 =.43, (p<.001). Explanatory factors for the EQ-5D-3L were level of VI in the better eye, comorbidities and gender, R 2 =.36, (p<.001). ConclusionsOur results showed that the EQ-5D-3L is useful when characterizing the burden of VI and to compute, when necessary, quality-adjusted-life-years (QALY) changes due to VI. However, is important to consider that the EQ-5D-3L uses a coarse response scale, assesses a limited spectrum of domains and is influenced by comorbidities. This might limit its responsiveness to small changes in visual ability.

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Section: Discussioncontrasting

confidence: 56%

Visual and health outcomes, measured with the activity inventory and the EQ‐5D, in visual impairment

Macedo

Ramos

Hernández-Moreno

et al. 2017

Acta Ophthalmologica

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“…Health state utility weights obtained from the available literature 63 were used to quality adjust the time spent by patients in each visual acuity state, so as to generate QALYs. Health state utilities reflect the relative desirability of different states of health on a scale where zero represents death and one represents full health.…”

Section: Model Overviewmentioning

confidence: 99%

Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema: a prospective, multicentre, UK study

Olson

Sharp²,

Goatman³

et al. 2013

Health Technology Assessment

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“…In addition, the results are conditional on the model structure and the evidence used to inform it. For example, we used the results from the study by Lloyd et al, 97 which assessed, using the EQ-5D, the utility associated with visual acuity. However, as with the other three studies identified, this association was only available for the best eye (in terms of visual acuity).…”

Section: Figure 19mentioning

confidence: 99%

“…For the model we used the results from the study by Lloyd et al, 97 which assessed, using the European Quality of Life-5 Dimensions (EQ-5D™), the utility associated with visual acuity (as measured using the logMAR scale in the better seeing eye) in 49 patients with diabetes but no retinopathy and 122 patients with DR. The study identified, through multiple regression, that age, disease-specific quality of life (as measured using the National Eye Institute Visual Functioning Questionnaire) and visual acuity were all independent predictors of health utility.…”

Section: Health Utility and Quality-adjusted Life Expectancymentioning

confidence: 99%

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

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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.

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Health utility values associated with diabetic retinopathy

Cited by 67 publications

References 26 publications

Visual and health outcomes, measured with the activity inventory and the EQ‐5D, in visual impairment

Visual and health outcomes, measured with the activity inventory and the EQ‐5D, in visual impairment

Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema: a prospective, multicentre, UK study

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

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