Cost-Effectiveness Analysis of the screening program for Diabetic Retinopathy at primary healthcare level in Patients with type 2 Diabetes Mellitus in Danang city, Vietnam

ObjectiveThis study is to evaluate the cost-effectiveness of an annual screening program for diabetic retinopathy (DR) at primary healthcare level among patients with type 2 diabetes mellitus (type 2 DM) from a societal perspective in Danang city, Vietnam. MethodsA Markov model was developed to compare costs and effects of an annual screening program for DR using non-mydriatic fundus photography with the absence of the screening on a cohort of 23,951 patients with type 2 DM aged 40 years in Danang city from a societal perspective over a lifetime horizon of 40 years. The effect was estimated using quality-adjusted life years (QALY). Costs were measured in both Viet Nam Dong and US dollar. Both costs and effects were discounted annually at 3%. One-way and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. ResultsThe ICER for the DR screening program compared with the absence of screening was VND 86,631,252 per QALY (USD 3,630/QALY). In the one-way sensitivity analyses, a decrease in the screening participation rate, screening every two years, lower sensitivity of fundus photography and the poor treatment compliance rate, as well as an increase in costs of screening and treatment, which all led to higher ICER values. Increasing the incidence of DM did not change ICER value. Conversely, reducing treatment costs caused lower ICER. At a willingness-to-pay (WTP) threshold of VND 86,631,252 (USD 3,630) per QALY, the probability of the screening program being cost-effective was 92.3%. When the WTP increases at VND 95,294,377 (USD 3,993) or higher, the probability of cost-effectiveness approached 100%. ConclusionDiabetic retinopathy screening for patients with type 2 diabetes for aged 40 to 80 years is cost-effective in Danang city, Vietnam according to World Health Organization criteria.