Cost effectiveness analysis of screening for sight threatening diabetic eye disease

Objective To measure the cost effectiveness of systematic photographic screening for sight threatening diabetic eye disease compared with existing practice. Design Cost effectiveness analysis. Setting Liverpool. Subjects A target population of 5000 diabetic patients invited for screening. Main outcome measures Cost effectiveness (cost per true positive) of systematic and opportunistic programmes; incremental cost effectiveness of replacing opportunistic with systematic screening. Results Baseline prevalence of sight threatening eye disease was 14.1%. The cost effectiveness of the systematic programme was pound 209 (sensitivity 89%, specificity 86%, compliance 80%, annual cost pound 104 996) and of the opportunistic programme was pound 289 (combined sensitivity 63%, specificity 92%, compliance 78%, annual cost pound 99 981). The incremental cost effectiveness of completely replacing the opportunistic programme was pound 32. Absolute values of cost effectiveness were highly sensitive to varying prevalence, sensitivity and specificity, compliance, and programme size. Conclusion Replacing existing programmes with systematic screening for diabetic eye disease is justified.