Crijns H, Casparie A F, Hendrikse F
Erasmus Universiteit, Instituut Beleid en Management Gezondheidszorg, Rotterdam.
Ned Tijdschr Geneeskd. 1995 Jul 1;139(26):1336-41.
To determine how much vision loss caused by diabetic retinopathy can be prevented in the Netherlands until 2020, and what resources will be needed to do so.
Computer simulation study.
The population forecasts of the Dutch Central Bureau of Statistics constituted the starting points. The literature provided data on the disease progression and the effectiveness of screening and treatment. A new continuous computer simulation assessed one scenario without eye care and four scenarios with different screening frequencies. Effects were measured in sight gain, costs were based on official charges, benefits included savings on disability facilities and reductions in production losses.
The number of diabetic patients was estimated to increase form 287,000 in 1993 to 406,000 in 2020. Compared with a setting without ophthalmic care, full compliance with official screening guidelines would reduce the prevalence of blindness in 2020 by 45% among type I patients, and by 20% among type II patients. Financial benefits would exceed costs for type I, but not for type II diabetes. While the intensity of eye care would rise, the number of eye examinations would increase approximately in the same proportion, but the number of laser treatments would increase at a much slower rate. 30% more ophthalmologists were estimated to be required in 2020.
The sharp increase in the number of diabetic patients plus the proven effectiveness of photocoagulation will inevitably cause a major rise in the need for ophthalmic care.
确定到2020年在荷兰可预防多少由糖尿病视网膜病变导致的视力丧失，以及为此需要哪些资源。
计算机模拟研究。
以荷兰中央统计局的人口预测为起点。文献提供了疾病进展以及筛查和治疗效果的数据。一项新的连续计算机模拟评估了一种无眼部护理的情况和四种不同筛查频率的情况。效果以视力改善来衡量，成本基于官方收费，益处包括残疾设施费用的节省和生产损失的减少。
估计糖尿病患者数量将从1993年的28.7万增加到2020年的40.6万。与无眼科护理的情况相比，完全遵守官方筛查指南将使2020年I型患者的失明患病率降低45%，II型患者降低20%。I型糖尿病的经济收益将超过成本，但II型糖尿病则不然。虽然眼部护理的强度会增加，但眼科检查的数量将大致以相同比例增加，而激光治疗的数量增加速度要慢得多。预计到2020年需要多30%的眼科医生。
糖尿病患者数量的急剧增加加上已证实的光凝治疗效果将不可避免地导致眼科护理需求大幅上升。
