Department of Ophthalmology, Oslo University Hospital, 0450, Oslo, Norway.
Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway.
Sci Rep. 2024 Jul 6;14(1):15618. doi: 10.1038/s41598-024-66405-2.
To compare two screening strategies for diabetic retinopathy (DR), and to determine the health-economic impact of including optical coherence tomography (OCT) in a regular DR screening. This cross-sectional study included a cohort of patients (≥ 18 years) with type 1 or 2 diabetes mellitus (T1D or T2D) from a pilot DR screening program at Oslo University Hospital, Norway. A combined screening strategy where OCT was performed in addition to fundus photography for all patients, was conducted on this cohort and compared to our existing sequential screening strategy. In the sequential screening strategy, OCT was performed on a separate day only if fundus photography indicated diabetic macular edema (DME). The presence of diabetic maculopathy on fundus photography and DME on OCT was determined by two medical retina specialists. Based on the prevalence rate of diabetic maculopathy and DME from the pilot, we determined the health-economic impact of the two screening strategies. The study included 180 eyes of 90 patients. Twenty-seven eyes of 18 patients had diabetic maculopathy, and of these, 7 eyes of 6 patients revealed DME on OCT. When diabetic maculopathy was absent on fundus photographs, OCT could not reveal DME. Accordingly, 18 patients (20%) with diabetic maculopathy would have needed an additional examination with OCT in the sequential screening strategy, 6 (33%) of whom would have had DME on OCT. In an extended healthcare perspective analysis, the cost of the sequential screening strategy was higher than the cost of the combined screening strategy. There was a weak association between diabetic maculopathy on fundus photography and DME on OCT. The health economic analysis suggests that including OCT as a standard test in DR screening could potentially be cost-saving.
为了比较两种糖尿病视网膜病变（DR）的筛查策略，并确定在常规 DR 筛查中纳入光学相干断层扫描（OCT）的健康经济学影响。本研究纳入了挪威奥斯陆大学医院 DR 筛查试点项目的 1 型或 2 型糖尿病（T1D 或 T2D）患者队列（≥18 岁）。对该队列进行了一种联合筛查策略，即在所有患者中除眼底照相外还进行 OCT 检查，并与现有的序贯筛查策略进行比较。在序贯筛查策略中，如果眼底照相提示存在糖尿病性黄斑水肿（DME），则仅在单独的一天进行 OCT 检查。两名医学视网膜专家通过眼底照相和 OCT 确定糖尿病性视网膜病变和 DME 的存在。基于试点研究的糖尿病性视网膜病变和 DME 的患病率，我们确定了两种筛查策略的健康经济学影响。该研究纳入了 90 名患者的 180 只眼。18 名患者的 27 只眼患有糖尿病性视网膜病变，其中 6 名患者的 7 只眼在 OCT 上显示 DME。当眼底照相上没有糖尿病性视网膜病变时，OCT 无法发现 DME。因此，在序贯筛查策略中，18 名（20%）患有糖尿病性视网膜病变的患者需要进行额外的 OCT 检查，其中 6 名（33%）患者在 OCT 上有 DME。在扩展的医疗保健视角分析中，序贯筛查策略的成本高于联合筛查策略的成本。眼底照相上的糖尿病性视网膜病变与 OCT 上的 DME 之间存在弱相关性。健康经济学分析表明，将 OCT 作为 DR 筛查的标准测试可能具有成本效益。
