{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T18:11:25Z","timestamp":1778004685097,"version":"3.51.4"},"reference-count":35,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,4,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic retinopathy (DR) is a leading cause of preventable blindness among people with type 2 diabetes mellitus (T2DM). Early detection is essential to prevent vision-threatening complications. This study evaluated the long-term cost-effectiveness of CODMAP (Ophthalmologic Screening for Diabetes Mellitus in Primary Care (Cribado Oftalmol\u00f3gico en Diabetes Mellitus en Atenci\u00f3n Primaria)), an optimised screening programme combining two-field non-mydriatic fundus photography (NMFP) and optical coherence tomography versus conventional single-field NMFP in a public healthcare setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A Markov model simulated DR progression over 50 years in a cohort of 7729\u2009patients with T2DM. Eight health states reflected DR severity, with state-specific costs and quality-adjusted life years (QALYs) accrued annually. Analyses took the perspective of the Spanish National Health Service, applying a 3% annual discount rate. Incremental cost-effectiveness ratios, calculated as a ratio of means (ICERs\n                      <jats:sub>ROM<\/jats:sub>\n                      ), and net monetary benefits (NMBs) were estimated through 10\u2009000 Monte Carlo simulations, at a \u20ac30 000 willingness-to-pay threshold. Deterministic and probabilistic sensitivity analyses, scenario analyses and bootstrap validation were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CODMAP accrued higher costs (\u20ac206.4 million vs \u20ac205.1 million) but more QALYs (128\u2009691.7 vs 118 013.8), resulting in an ICER\n                      <jats:sub>ROM<\/jats:sub>\n                      of \u20ac124.25\/QALY. The probability of cost-effectiveness at \u20ac30 000\/QALY was 74.3%, remaining stable in scenario analyses (75.7%\u201378.8%). Mean incremental NMB in the base case was \u20ac319.0 million. Cost and QALY variations were the main drivers of uncertainty.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CODMAP offers greater long-term health gains at a favourable incremental cost per QALY in the Spanish context. However, the non-definitive probability of cost-effectiveness warrants cautious policy consideration, with attention to local infrastructure, implementation capacity and cost structures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-327884","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:20:47Z","timestamp":1778001647000},"page":"bjo-2025-327884","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of OCT-enhanced screening for diabetic retinopathy: a 50-year Markov model analysis in type 2 diabetes"],"prefix":"10.1136","author":[{"given":"Susana","family":"Ruiz Bilbao","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariadna","family":"Mas Casals","sequence":"additional","affiliation":[{"name":"Direcci\u00f3 Assistencial d\u2019Atenci\u00f3 Prim\u00e0ria i a la Comunitat, Institut Catal\u00e0 de la Salut, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"G\u00f3mez S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5240-2066","authenticated-orcid":false,"given":"Pablo","family":"D\u00edaz-Aljaro","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3353-5186","authenticated-orcid":false,"given":"Thiago","family":"Carnaval","sequence":"additional","affiliation":[{"name":"Department of Research, Innovation and Learning, Sant Joan de Deu Hospital, Esplugues de Llobregat, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoni","family":"Sabala","sequence":"additional","affiliation":[{"name":"Servei d\u2019Oftalmologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oriol","family":"Estrada Cuxart","sequence":"additional","affiliation":[{"name":"Directorate of Healthcare Strategy and Innovation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebasti\u00e1n","family":"Videla","sequence":"additional","affiliation":[{"name":"\u00c0rea de Suport a la Recerca Cl\u00ednica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"2026050510204229000_bjo-2025-327884v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)62124-3"},{"key":"2026050510204229000_bjo-2025-327884v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2018.04.007"},{"key":"2026050510204229000_bjo-2025-327884v1.3","doi-asserted-by":"crossref","DOI":"10.1186\/s40662-015-0026-2","article-title":"Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss","volume":"2","author":"Lee","year":"2015","journal-title":"Eye Vis (Lond)"},{"key":"2026050510204229000_bjo-2025-327884v1.4","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1016\/S2214-109X(13)70113-X","article-title":"Causes of vision loss worldwide, 1990-2010: a systematic analysis","volume":"1","author":"Bourne","year":"2013","journal-title":"Lancet Glob Health"},{"key":"2026050510204229000_bjo-2025-327884v1.5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-124-1_Part_2-199601011-00017"},{"key":"2026050510204229000_bjo-2025-327884v1.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.299.6709.1198"},{"key":"2026050510204229000_bjo-2025-327884v1.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1005073"},{"key":"2026050510204229000_bjo-2025-327884v1.8","unstructured":"Ophthalmology ICo . 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