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Cost-effectiveness of digital photographic screening for retinopathy of prematurity in the United Kingdom

Published online by Cambridge University Press:  28 May 2004

Marianela C. Castillo-Riquelme ,
Joanne Lord ,
Merrick J. Moseley ,
Alistair R. Fielder  and
Linda Haines
Marianela C. Castillo-Riquelme
Affiliation:
London School of Hygiene & Tropical Medicine
Joanne Lord
Affiliation:
Imperial College of London
Merrick J. Moseley
Affiliation:
Imperial College of London
Alistair R. Fielder
Affiliation:
Imperial College of London
Linda Haines
Affiliation:
Royal College of Paediatrics and Child Health
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Abstract

Objectives: To compare the cost-effectiveness of alternative methods of screening for retinopathy of prematurity (ROP) in the United Kingdom, including the existing method of indirect ophthalmoscopy by ophthalmologists and digital photographic screening by nurses.

Methods: A decision tree model was used to compare five screening modalities for the UK population of preterm babies, using a health service perspective. Data were taken from published sources, observation at a neonatal intensive care unit (NICU), and expert judgment.

Results: We estimated that use of standard digital cameras by nurses in NICUs would cost more than current methods (£371 compared with £321 per baby screened). However, a specialist nurse visiting units with a portable camera would be cheaper (£172 per baby). These estimates rely on nurses capturing and interpreting the images, with suitable training and supervision. Alternatively, nurses could capture the images then transmit them to a central unit for interpretation by ophthalmologists, although we estimate that this would be rather more expensive (£390 and £201, respectively, for NICU and visiting nurses). Sensitivity analysis was used to examine the robustness of estimates.

Conclusions: It is likely that there is an opportunity to improve the efficiency of the ROP screening program. We estimate that screening by specialist nurses trained in image capture and interpretation using portable digital cameras is a cost-effective alternative to the current program of direct visualization by ophthalmologists. This option would require the development of a suitable portable machine. Direct comparative research is strongly needed to establish the accuracy of the various screening options.

Keywords

Preterm (or premature) babiesRetinopathy of prematurityDigital photographyScreeningCost-effectiveness analysisDecision trees
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 2 , April 2004 , pp. 201 - 213
Copyright
© 2004 Cambridge University Press

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References

Brown GC, Brown MM, Sharma S, et al. 1999 Cost-effectiveness of treatment for threshold retinopathy of prematurity. Pediatrics. 104: e47.Google Scholar
Committee for the Classification of Retinopathy of Prematurity. 1984 An international classification of retinopathy of prematurity. Arch Ophthalmol. 102: 1130– 1134.
Connolly BP, McNamara JA, Sharma S, et al. 1998 A comparison of laser photocoagulation with trans-scleral cryotherapy in the treatment of threshold retinopathy of prematurity. Ophthalmology. 105: 1628– 1631.Google Scholar
Connolly BP, Ng EY, McNamara JA, et al. 2002 A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years. II. Refractive outcome. Ophthalmology. 109: 936– 941.Google Scholar
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 2001 Contrast sensitivity at age 10 years in children who had threshold retinopathy of prematurity. Arch Ophthalmol. 119: 1129– 1133.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 2001 Effect of retinal ablative therapy for threshold retinopathy of prematurity: Results of Goldmann perimetry at the age of 10 years. Arch Ophthalmol. 119: 1120– 1125.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 1993 Multicenter trial of cryotherapy for retinopathy of prematurity. 3 1/2-year outcome–structure and function. Arch Ophthalmol. 111: 339– 344.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 1990 Multicenter trial of cryotherapy for retinopathy of prematurity. One-year outcome–structure and function. Arch Ophthalmol. 108: 1408– 1416.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 1988 Multicenter trial of cryotherapy for retinopathy of prematurity. Preliminary results. Arch Ophthalmol. 106: 471– 479.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 1996 Multicenter trial of cryotherapy for retinopathy of prematurity. Snellen visual acuity and structural outcome at 5 1/2 years after randomization. Arch Ophthalmol. 114: 417– 424.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 1990 Multicenter trial of cryotherapy for retinopathy of prematurity. Three-month outcome. Arch Ophthalmol. 108: 195– 204.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 2002 Multicenter trial of cryotherapy for retinopathy of prematurity: Natural history ROP: Ocular outcome at 5(1/2) years in premature infants with birth weights less than 1251 g. Arch Ophthalmol. 120: 595– 599.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 2001 Multicenter trial of cryotherapy for retinopathy of prematurity: Ophthalmological outcomes at 10 years. Arch Ophthalmol. 119: 1110– 1118.
Cryotherapy for Retinopathy of Prematurity Cooperative Group. 1994 The natural ocular outcome of premature birth and retinopathy. Status at 1 year. Arch Ophthalmol. 112: 903– 912.
Drummond MF. 1988 Economic aspects of cataract. Ophthalmology. 95: 1147– 1153.Google Scholar
Fielder AR, Haines L, Scrivener R, et al. 2002 Retinopathy of prematurity in the UK. II: Audit of national guidelines for screening and treatment. Eye. 16: 285– 291.Google Scholar
Fleck BW. 1999 Therapy for retinopathy of prematurity. Lancet. 353.Google Scholar
Flynn JT. 2002 Comparison of laser and cryotherapy for ROP, discussion. Ophthalmology. 109: 935.Google Scholar
Gilbert C, Rahi J, Eckstein M, et al. 1997 Retinopathy of prematurity in middle-income countries. Lancet. 350: 12– 14.Google Scholar
Goggin M, O'Keefe M. 1991 Childhood blindness in the Republic of Ireland: A national survey. Br J Ophthalmol. 75: 425– 429.Google Scholar
Haines L, Fielder AR, Scrivener R, et al. 2002 Retinopathy of prematurity in the UK. I: The organisation of services for screening and treatment. Eye. 16: 33– 38.Google Scholar
Heneghan C, Flynn J, O'Keefe M, et al. 2002 Characterization of changes in blood vessel width and tortuosity in retinopathy of prematurity using image analysis. Med Image Anal. 6: 407– 429.Google Scholar
Javitt J, Dei Cas R, Chiang YP. 1993 Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity. Pediatrics. 91: 859– 866.Google Scholar
Joint Working Party of The Royal College of Ophthalmologists and the British Association of Perinatal Medicine. 1996 Retinopathy of prematurity: Guidelines for screening and treatment. Early Hum Dev. 46: 239– 258.
Joint Working Party of the Royal College of Paediatrics and Child Health the Royal College of Ophthalmologist and the British Association of Perinatal Medicine. 2002 A 5 years programme of research into the Screening and Treatment of Retinopathy of Prematurity in the UK. London: Royal College of Paediatrics and Child Health 71.
Kocur I, Kuchynka P, Rodny S, et al. 2001 Causes of severe visual impairment and blindness in children attending schools for the visually handicapped in the Czech Republic. Br J Ophthalmol. 85: 1149– 1152.Google Scholar
Lorenz B, Bock M, Muller HM, et al. 1999 Telemedicine based screening of infants at risk for retinopathy of prematurity. Stud Health Technol Inform. 64: 155– 163.Google Scholar
Munoz B, West SK. 2002 Blindness and visual impairment in the Americas and the Caribbean. Br J Ophthalmol. 86: 498– 504.Google Scholar
Netten A, Rees T, Harrison G. 2001 Unit costs of health and social care 2001. Canterbury: Personal Social Services Research Unit, University of Kent at Canterbury
Ng EY, Connolly BP, McNamara JA, et al. 2002 A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years. I. Visual function and structural outcome. Ophthalmology. 109: 928– 934.Google Scholar
Nguyen QD, Tawansy K, Hirose T. 2001 Recent advances in retinopathy of prematurity. Int Ophthalmol Clin. 41: 129– 151.Google Scholar
Raftery J. 2001 NICE: Faster access to modern treatments? Analysis of guidance on health technologies. BMJ. 323: 1300– 1303.Google Scholar
Roth DB, Morales D, Feuer WJ, et al. 2001 Screening for retinopathy of prematurity employing the retcam 120: Sensitivity and specificity. Arch Ophthalmol. 119: 268– 272.Google Scholar
Schwartz SD, Harrison SA, Ferrone PJ, et al. 2000 Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera. Ophthalmology. 107: 25– 28.Google Scholar
Shapiro DE. 1999 The interpretation of diagnostic tests. Stat Methods Med Res. 8: 113– 134.Google Scholar
Swanson C, Cocker KD, Parker KH, et al. Semi-automated computer analysis of vessel growth in preterm infants without and with ROP. Submitted.
Towse A, Pritchard C, Devlin N. 2002 Cost-effectiveness thresholds: Economic and ethical issues. London: Office of Health Economics
TreeAge Software I. 1999 DATA 3.5 for HEALTHCARE User's Manual. Williamstown, MA: Microsoft Corporation
Wheatley CM, Dickinson JL, Mackey DA, et al. 2002 Retinopathy of prematurity: Recent advances in our understanding. Br J Ophthalmol. 86: 696– 700.Google Scholar
Department of Health—United Kingdom. Available at: www.doh.gov.uk/nhsexec/refcosts.htm. Accessed: August 13, 2002.
Organisation for Economic Co-operation and Development. Available at: www.oedcd.org/en/statistics/. Accessed: September 8, 2002.
Ziakas NG, Cottrell DG, Milligan DW, et al. 2001 Regionalisation of retinopathy of prematurity (ROP) screening improves compliance with guidelines: An audit of ROP screening in the Northern Region of England. Br J Ophthalmol. 85: 807– 810.Google Scholar