The impact of a co-payment on the cost-effectiveness of screening for diabetic retinopathy

Jinxiao Lian, Sarah M. McGhee, Rita A. Gangwani, Christina Ka Wai Chan, Cindy Lo Kuen Lam, Keng Hung Maurice Yap, David Sai Hung Wong

Research output: Journal article publicationJournal articleAcademic researchpeer-review

7 Citations (Scopus)


Background: To determine the impact of a co-payment on the cost-effectiveness of systematic screening for diabetic retinopathy in Hong Kong (HK). Methods: An analysis was conducted from provider and societal perspectives. A Markov cohort model was used to determine the cost-effectiveness of screening with a co-payment of HK$60 (US$7.7) compared with free screening, with and without an assumption that the inverse care law (ICL) would operate in the presence of a fee as seen in our previous data. Results: From the provider perspective, the incremental cost-effectiveness ratio (ICER) of free versus pay systematic screening was HK$166 558 (US$21 354)/extra quality adjusted life year (QALY) gained assuming an effect of the ICL and free screening was always more cost-effective than pay screening when willingness to pay for a QALY was HK$124 488 (US$15 960) or above. Without an effect of the ICL, the ICER was HK$480 479 (US$61 600)/extra QALY gained. From the societal perspective, the ICER was HK$144 046 (US$18 467)/extra QALY gained with an effect of the ICL and HK$199 741 (US$25 608)/extra QALY gained with no effect. Conclusions: Free systematic screening was highly cost-effective from the societal perspective compared with screening with a small co-payment irrespective of the effects of the ICL. From the provider perspective, free screening was highly cost-effective if the ICL operates.
Original languageEnglish
Pages (from-to)782-792
Number of pages11
JournalJournal of Public Health (United Kingdom)
Issue number4
Publication statusPublished - 1 Jan 2016


  • Cost-effectiveness
  • Eye disorders
  • Health services

ASJC Scopus subject areas

  • General Medicine
  • Public Health, Environmental and Occupational Health


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