Cost effectiveness analysis of screening for sight threatening diabetic eye disease

Objective To measure the cost effectiveness of systematic photographic scre ening for sight threatening diabetic eye disease compared with existing pra ctice. Design Cost effectiveness analysis. Setting Liverpool. Subjects A target population of 5000 diabetic patients invited for screenin g. Main outcome measures Cost effectiveness (cost per true positive) of system atic and opportunistic programmes; incremental cost effectiveness of replac ing 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%, specifici ty 92%, compliance 78%, annual cost pound 99 981). The incremental cost eff ectiveness of completely replacing the opportunistic programme was pound 32 . Absolute values of cost effectiveness were highly sensitive to varying pr evalence, sensitivity and specificity, compliance, and programme size. Conclusion Replacing existing programmes with systematic screening for diab etic eye disease is justified.