TY - JOUR
T1 - Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model
AU - Day, T. Eugene
AU - Ravi, Nathan
AU - Xian, Hong
AU - Brugh, Ann
N1 - Funding Information:
Financial Support: This paper was supported by a Veterans Administration Health Services Research and Development Merit Review Pilot Grant, PPO 11–167. The sponsor or funding organization had no role in the design or conduct of this research.
PY - 2014/4/1
Y1 - 2014/4/1
N2 - Objective: To examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk. Methods: Simulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans - using abstracted data from a retrospective cohort of real-world diabetic Veterans - with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group. Results: Diabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98). Conclusions: Increasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss.
AB - Objective: To examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk. Methods: Simulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans - using abstracted data from a retrospective cohort of real-world diabetic Veterans - with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group. Results: Diabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98). Conclusions: Increasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss.
KW - Agent based modeling
KW - Diabetic eye screen
KW - Diabetic retinopathy
KW - Discrete event simulation
UR - http://www.scopus.com/inward/record.url?scp=84893493253&partnerID=8YFLogxK
U2 - 10.1016/j.compbiomed.2014.01.007
DO - 10.1016/j.compbiomed.2014.01.007
M3 - Article
C2 - 24508563
AN - SCOPUS:84893493253
SN - 0010-4825
VL - 47
SP - 7
EP - 12
JO - Computers in Biology and Medicine
JF - Computers in Biology and Medicine
IS - 1
ER -