Javitt J C, Canner J K, Sommer A
Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Baltimore, MD 21205.
Ophthalmology. 1989 Feb;96(2):255-64. doi: 10.1016/s0161-6420(89)32923-x.
Diabetic retinopathy is a leading cause of blindness among working age Americans. The epidemiology of diabetic eye disease has been well described in population-based studies and the effects of laser treatment have been tested in randomized controlled trials. The authors have designed a computer simulation model using the published reports of these studies to predict the medical and economic effects of applying currently accepted methods for the control of diabetic retinopathy to the population of type I diabetics. Recommendations for screening are taken from the Public Health Committee of the American Academy of Ophthalmology. Treatment recommendations and treatment efficacy are drawn from the reports of the Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS). Costs of screening and treatment are drawn from published Medicare reimbursement data. Over a 60-year period, the model predicts that proliferative diabetic retinopathy (PDR) requiring panretinal photocoagulation (PRP) will eventually develop in 72% of type I diabetics and macular edema will develop in 42%. If these treatments are delivered as recommended in the clinical trials, the model predicts a cost of $966 per person-year of vision saved from proliferative retinopathy and $1118 per person-year of central acuity saved from macular edema. This is only one seventh of the $6900 average cost of 1 year of Social Security Disability for those disabled by vision loss. Therefore, this model supports the use of federally funded eye care to prevent blindness in medically uninsured diabetics.
糖尿病视网膜病变是美国工作年龄人群失明的主要原因。糖尿病眼病的流行病学在基于人群的研究中已有详尽描述，激光治疗的效果也已在随机对照试验中得到检验。作者利用这些研究的已发表报告设计了一个计算机模拟模型，以预测将目前公认的糖尿病视网膜病变控制方法应用于1型糖尿病患者群体所产生的医学和经济影响。筛查建议取自美国眼科学会公共卫生委员会。治疗建议和治疗效果取自糖尿病视网膜病变研究（DRS）和早期糖尿病视网膜病变研究（ETDRS）的报告。筛查和治疗成本取自已公布的医疗保险报销数据。在60年的时间里，该模型预测，72%的1型糖尿病患者最终会发展为需要进行全视网膜光凝（PRP）的增殖性糖尿病视网膜病变（PDR），42%的患者会出现黄斑水肿。如果按照临床试验中的建议进行这些治疗，该模型预测，从增殖性视网膜病变中挽救一年视力的人均成本为966美元，从黄斑水肿中挽救一年中心视力的人均成本为1118美元。这仅为因视力丧失而致残者一年社会保障残疾平均成本6900美元的七分之一。因此，该模型支持利用联邦资助的眼科护理来预防未参保糖尿病患者失明。
