Dasbach E J, Fryback D G, Newcomb P A, Klein R, Klein B E
Department of Industrial Engineering, University of Wisconsin-Madison 53706.
Med Care. 1991 Jan;29(1):20-39. doi: 10.1097/00005650-199101000-00003.
A computer model has been developed to determine cost-effectiveness of screening and treatment for diabetic retinopathy from a societal viewpoint. This model was used to evaluate biannual and annual screening programs using ophthalmoscopy, fundus photography with a "nonmydriatic camera," and photography with a "mydriatic camera." Computations were performed for three subpopulations formed by patients with younger onset diabetes (age at diagnosis less than 30 years) of 5 years or more duration, with older onset diabetes (age at diagnosis greater than or equal to 30 years) who are taking insulin, and with older onset diabetes not taking insulin. Population characteristics are from a well-described southern Wisconsin population where data are available, but the computer model may be specialized to other population. Generally costs of screening programs appear to be recovered by avoided costs of blindness in the population subgroups taking insulin; however, the cost of screening programs generally are not recovered by avoiding costs of blindness in the older onset population subgroup not taking insulin. It was estimated that supplying annual examination with mydriatic fundus photography as a screening program to a cohort of 1,000 diabetics from the younger onset population who have been diagnosed at least 5 years and who are currently not receiving care might save 319 sight years over the lifetime of the cohort. This program will save 62 sight years in an older onset cohort who are taking insulin, and 21 sight years in the older onset population not taking insulin (all benefits are presented as present values computed with an annual discount rate of 5%). Other programs achieve slightly lower savings in each subpopulation.
已开发出一种计算机模型，用于从社会角度确定糖尿病视网膜病变筛查和治疗的成本效益。该模型用于评估使用检眼镜、配备“免散瞳相机”的眼底摄影以及配备“散瞳相机”的摄影进行的半年一次和每年一次的筛查项目。对三个亚人群进行了计算，这三个亚人群分别由糖尿病发病年龄较轻（诊断时年龄小于30岁）且病程达5年或更长时间的患者、正在使用胰岛素的糖尿病发病年龄较大（诊断时年龄大于或等于30岁）的患者以及未使用胰岛素的糖尿病发病年龄较大的患者组成。人群特征来自威斯康星州南部一个描述详尽且有数据可用的人群，但该计算机模型也可针对其他人群进行专门化设置。一般来说，在使用胰岛素的人群亚组中，筛查项目的成本似乎可通过避免失明成本而得以收回；然而，在未使用胰岛素的老年发病人群亚组中，筛查项目的成本通常无法通过避免失明成本而收回。据估计，为一组1000名来自发病年龄较轻人群、已被诊断至少5年且目前未接受治疗的糖尿病患者提供每年一次的散瞳眼底摄影筛查项目，在该队列的一生中可能节省319个视力年。该项目将在使用胰岛素的老年发病队列中节省62个视力年，在未使用胰岛素的老年发病人群中节省21个视力年（所有效益均以5%的年贴现率计算的现值呈现）。其他项目在每个亚人群中实现的节省略低。
