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. 2020 Jun 30;105(5):723–728. doi: 10.1136/bjophthalmol-2020-316594

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Decision tree model used to calculate the incremental cost-effectiveness of human grading versus replacing initial grading undertaken by human graders (primary graders) with automated retinal image analysis systems (ARIAS).^{5 6} The clinical practice pathway as illustrated reflects the pathway and grading²³ that was used in previous cost-effectiveness analyses.^{5 6} Non-referable retinopathy refers to human grades of no observable retinopathy (R0) and mild-to-moderate non-proliferative retinopathy (R1) and non-referable maculopathy (M0). Referable retinopathy refers to referable maculopathy (M1), moderate-to-severe non-proliferative retinopathy (R2) and proliferative retinopathy (R3) and ungradable images (U).^{8 9} DESP, Diabetic Eye Screening Programme; DR, diabetic retinopathy.