Table 3.

Costs, QALYs, and Cost-Effectiveness of Five Diabetic Retinopathy Screening and Treatment Alternatives Considering the Impacts of Diabetic Retinopathy Alone and the Impacts of Diabetic Retinopathy, AMD, Glaucoma, and URE

	Outcomes		ICER		INB Given WTP = U.S.$50,000 per QALY gained
Scenarios	Total Cost (CI)	QALYs (CI)	Versus Self-Referral	Versus Next Most Expensive Option	Versus Self-Referral	Probability Cost-Effective	Versus Next Most Expensive Option	Probability Cost-Effective
Self-referral at visual loss	U.S.$7,368	10.1646
	(U.S.$6.127–U.S.$8,610)	(10.1643–10.1648)
Annual telemedicine	U.S.$10,711	10.2254	U.S.$54,979		−U.S.$303	0.37
	(U.S.$9,045–U.S.$12,378)	(10.2251–10.2256)			(−U.S.$3,185–U.S.$2,579)
Biennial evaluation	U.S.$11,004	10.2614	U.S.$37,531	U.S.$8,107	U.S.$1,208	0.93	U.S$1,511	0.98
	(U.S.$8,515–U.S.$13,493)	(10.2612–10.2617)			(−U.S.$2,497–U.S.$4,912)		(−U.S.$2,619–U.S.$5,640)
Annual evaluation	U.S.$12,177	10.2700	U.S.$45,586	U.S.$136,170	U.S.$466	0.70	−U.S.$742	0.15
	(U.S.$9,213–U.S.$15,141)	(10.2698–10.2703)			(−U.S.$3,714–U.S.$4,645)		(−U.S.$6,169–U.S.$4,685)

Notes. Productivity losses refer only to those that occur as a result of eye evaluations, dilation, or treatment of DR; they do not include losses from visual impairment as these are incorporated in QALY losses.

CI, credible interval; ICER, incremental cost effectiveness ratio = change in QALYs−change in costs; INB, incremental net benefit = WTP × change in QALYs−change in costs; MD, age-related macular degeneration; QALY, quality-adjusted life year; URE, uncorrected refractive error; WTP, willingness to pay.