Polak B C P, Crijns H, Casparie A F, Niessen L W
Department of Ophthalmology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Health Policy. 2003 Apr;64(1):89-97. doi: 10.1016/s0168-8510(02)00143-4.
Glycemic control and ophthalmological care are known to significantly diminish the risk of visual impairment and blindness by diabetic retinopathy (DRP). The (cost-)effectiveness of both strategies was studied to highlight their benefits for patients and care providers.
A computer analysis was developed, following the progression of DRP and the effectiveness of metabolic control and ophthalmological care continuously and individually in cohorts of type I and type II DM patients with divergent degrees of compliance. Costs relate to present medical charges in the Netherlands.
Intensive glycemic control shortens the duration of blindness in a type I DM patient by 0.76 years, intensive ophthalmological care by 0.53 years. One year sight gain may cost 1126 euros by providing ophthalmological care and 50479 euros by glycemic control. The duration of blindness drops in a type II DM patient by 0.48 and 0.13 years, respectively, whereas the effectiveness decreases as the age of onset of DM rises.
The vast majority of diabetic patients benefits from both intensive glycemic control and intensive ophthalmological care, but these cost-effective interventions which are not only complementary, but also substitute each other, require lasting, full compliance by all parties concerned.
已知血糖控制和眼科护理可显著降低糖尿病视网膜病变（DRP）导致视力损害和失明的风险。对这两种策略的（成本）效益进行了研究，以突出它们对患者和护理人员的益处。
开发了一种计算机分析方法，持续且分别跟踪I型和II型糖尿病患者队列中DRP的进展以及代谢控制和眼科护理的有效性，这些患者具有不同程度的依从性。成本与荷兰当前的医疗费用相关。
强化血糖控制可使I型糖尿病患者失明持续时间缩短0.76年，强化眼科护理可缩短0.53年。通过提供眼科护理获得一年视力改善的成本可能为1126欧元，通过血糖控制则为50479欧元。II型糖尿病患者失明持续时间分别缩短0.48年和0.13年，而随着糖尿病发病年龄的增加，效果会降低。
绝大多数糖尿病患者受益于强化血糖控制和强化眼科护理，但这些具有成本效益的干预措施不仅相互补充，而且相互替代，需要所有相关方持久、完全的依从性。
