AI Article Synopsis

  • England's Diabetic Eye Disease Screening Programme provides annual eye screenings for residents over 12 diagnosed with diabetes, but older individuals with diabetes may not benefit as much due to shorter life expectancy.
  • A study analyzed data from the Norfolk Diabetic Retinopathy Screening Programme (2006-2017) to assess the probability of receiving eye treatment based on the age at first screening and linked it to treatment and death data until 2021.
  • Findings revealed that older age at diagnosis increased death rates and decreased treatment probabilities, with screening costs rising significantly with age, suggesting that age limits or stratification for screening could be warranted.

Article Abstract

Aims: England's Diabetic Eye Disease Screening Programme offers screening to every resident over age 12 with diabetes, starting as soon as possible after diagnosis and repeated annually. People first diagnosed with diabetes at older ages have shorter life expectancy and therefore may be less likely to benefit from screening and treatment. To inform decisions about whether diabetic eye screening policy should be stratified by age, we investigated the probability of receiving treatment according to age at first screening episode.

Methods: This was a cohort study of participants in the Norfolk Diabetic Retinopathy Screening Programme from 2006 to 2017, with individuals' programme data linked to hospital treatment and death data recorded up to 2021. We estimated and compared the probability, annual incidence and screening costs of receiving retinal laser photocoagulation or intravitreal injection and of death, in age groups defined by age at first screening episode.

Results: The probability of death increased with increasing age at diagnosis, while the probability of receiving either treatment decreased with increasing age. The estimated cost of screening per person who received either or both treatments was £18,608 among all participants, increasing with age up to £21,721 in those aged 70-79 and £26,214 in those aged 80-89.

Conclusions: Diabetic retinopathy screening is less effective and less cost-effective with increasing age at diagnosis of diabetes, because of the increasing probability of death before participants develop sight-threatening diabetic retinopathy and can benefit from treatment. Upper age limits on entry into screening programmes or risk stratification in older age groups may, therefore, be justifiable.

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Source
http://dx.doi.org/10.1111/dme.15164DOI Listing

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