Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan.
Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan City, Taiwan.
Asia Pac J Ophthalmol (Phila). 2024 May-Jun;13(3):100071. doi: 10.1016/j.apjo.2024.100071. Epub 2024 May 19.
This study investigated the association between the frequency of screening for diabetic retinopathy (DR) versus the development of DR and corresponding medical expenses among patients newly diagnosed with type 2 diabetes mellitus (T2DM).
This longitudinal, population-based study used the Taiwan National Health Insurance Research Database (2004 to 2020) as a data source. Propensity score matching (PSM) (sex, age, comorbidities and concurrent medication use) was employed in the grouping of T2DM patients according to different frequency of DR screening. Outcome measures included the proportion of patients who developed DR, who received DR treatment, and the associated medical expenses and hospitalizations.
The 17-year cohort included 337,046 patients. After PSM, three groups each containing 35,739 patients were assembled and analyzed. Compared to low-frequency screening, high-frequency screening was more effective in detecting patients requiring treatment; however, the net cost for treatment was significantly lower. Standard-frequency screening appears to provide the best balance in terms of DR detection, diagnosis interval, the risk of DR-related hospitalization, and DR treatment costs.
In this real-world cohort study covering all levels of the healthcare system, infrequent screening was associated with delayed diagnosis and elevated treatment costs, while a fundus screening interval of 1-2 years proved optimal in terms of detection and medical expenditures.
本研究旨在探讨 2 型糖尿病（T2DM）新诊断患者中糖尿病视网膜病变（DR）筛查频率与 DR 发生发展及相应医疗费用之间的关系。
本纵向、基于人群的研究使用了台湾全民健康保险研究数据库（2004 年至 2020 年）作为数据来源。根据 DR 筛查频率的不同，采用倾向评分匹配（PSM）（性别、年龄、合并症和同时使用的药物）对 T2DM 患者进行分组。结局指标包括发生 DR、接受 DR 治疗以及相关医疗费用和住院的患者比例。
该 17 年队列包括 337046 名患者。经过 PSM 后，每组各包含 35739 名患者的三组被组装并进行了分析。与低频筛查相比，高频筛查更有效地发现需要治疗的患者；然而，治疗的净费用显著降低。标准频率筛查在 DR 检测、诊断间隔、DR 相关住院风险和 DR 治疗费用方面似乎提供了最佳的平衡。
在涵盖各级医疗保健系统的真实世界队列研究中，不频繁的筛查与延迟诊断和治疗费用升高有关，而 1-2 年的眼底筛查间隔在检测和医疗支出方面被证明是最佳的。
