Caption: A local ophthalmologist being trained to deliver laser photocoagulation for sight threatening diabetic retinopathy.
- Cost effectiveness
- Supporting initiatives
1. Cost effectiveness
A study in India estimated the utility values associated with different severity stages of diabetic retinopathy in India by a direct elicitation method (time-trade off, TTO) and indirectly by questionnaire. The study also demonstrated that screening for diabetic retinopathy in the rural teleophthalmology program was cost-effective ($1320 per QALY) compared with no screening from a health provider perspective, using the World Health Organization threshold of cost-effectiveness. Screening every 2 years was cost-effective, but annual screening was not.
- Polack S, Alavi Y, Rachapalle Reddi S, Kulothungan V, Kuper H. Utility values associated with diabetic retinopathy in Chennai, India. Ophthalmic Epidemiol. 2015 Feb;22(1):20-7. doi: 10.3109/09286586.2014.885057. Epub 2014 Mar 26. Abstract.
- Rachapelle S, Legood R, Alavi Y, Lindfield R, Sharma T, Kuper H, Polack S. The cost-utility of telemedicine to screen for diabetic retinopathy in India. Ophthalmology. 2013 Mar;120(3):566-73. doi: 10.1016/j.ophtha.2012.09.002. Epub 2012 Dec 1. Abstract.
2. Supporting initiatives to integrate diabetic retinopathy control into existing health systems in India
Caption: The National Diabetic Retinopathy Summit. 2014
India is home to over 65 million diabetics, and the number is projected to increase to over 100 million by the year 2030. It is estimated that 10% of people living with diabetes have the “sight threatening” form of diabetic retinopathy, which requires treatment. However, at the early stages even this advanced from of retinopathy can be associated with entirely normal vision, and so patients do not seek eye care. Once vision has been lost from diabetic retinopathy it usually cannot be reversed.
In India the Ministry of Health is scaling up their programme for the detection and treatment of people with non-communicable diseases, including diabetes. However, at the moment screening/detecting and treating diabetic retinopathy is not included in the programme.
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The Queen Elizabeth Diamond Jubilee Trust, who are supporting initiatives for the control of avoidable blindness across the Commonwealth, are supporting a large scale programme in India where the goal is to integrated initiatives for the control of visual loss from diabetic retinopathy into existing health systems. Staff at ICEH are playing a major role, providing technical and managerial input.
In order to inform decisions about what the Trust would support in India, a study was undertaken across the country to gather information on current services for people with diabetes, and for diabetic patients with diabetic retinopathy in order to identify gaps and best practices. Eleven major cities were visited across the country: 86 eye care providers were visited and 73 clinics caring for diabetics. In each location patients were interviewed (288 persons with diabetes and 376 with diabetic retinopathy). In addition, 14 eye care providers who run programmes for the detection and treatment of diabetic retinopathy were visited and their programmes evaluated for coverage, integration and partnerships, responsiveness, efficiency and effectiveness, and whether the approaches they used could be taken to scale. The findings were presented at a National Summit on Diabetic Retinopathy in 2014 where priorities for action were identified and the national programme outlined.
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