Cost-effectiveness and cost-utility of a digital technology-driven hierarchical healthcare screening pattern in China

作者：Xiaohang Wu, Yuxuan Wu, Zhenjun Tu, Zizheng Cao, Miaohong Xu, Yifan Xiang, Duoru Lin, Ling Jin, Lanqin Zhao, Yingzhe Zhang, Yu Liu, Yu Liu, Pisong Yan, Weiling Hu, Jiali Liu, Lixue Liu, Ruixin Wang, Ruixin Wang, Jieying Chen, Wei Xiao, Yuanjun Shang, Peichen Xie, Dongni Wang, Xulin Zhang, Meimei Dongye, Chenxinqi Wang, Daniel Shu Wei Ting, Yizhi Liu, Yizhi Liu, Rong Pan, Haotian Lin · 发表于：Nature Communications · 年份：2024 · DOI：10.1038/s41467-024-47211-w · 被引用次数：26 · 研究领域：Telemedicine and Telehealth Implementation、Healthcare Systems and Reforms

Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the mos...