Javitt J C, Aiello L P
Center for Sight, Georgetown University Medical Center, Washington, DC 20007, USA.
Ann Intern Med. 1996 Jan 1;124(1 Pt 2):164-9. doi: 10.7326/0003-4819-124-1_part_2-199601011-00017.
To determine, from the health insurer's perspective, the cost of preventing vision loss in patients with diabetes mellitus through ophthalmologic screening and treatment and to calculate the cost-effectiveness of these interventions as compared with that of other medical interventions.
Computer modeling, incorporating data from population-based epidemiologic studies and multicenter clinical trials. Monte Carlo simulation was used, combined with sensitivity analysis and present value analysis of cost savings.
Screening and treatment of eye disease in patients with diabetes mellitus costs $3190 per quality-adjusted life-year (QALY) saved. This average cost is a weighted average (based on prevalence disease) of the cost-effectiveness of detecting and treating diabetic eye disease in those with insulin-dependent diabetes mellitus ($1996 per QALY), those with non-insulin-dependent diabetes mellitus (NIDDM) who use insulin for glycemic control ($2933 per QALY), and those with NIDDM who do not use insulin for glycemic control ($3530 per QALY).
Our analysis indicates that prevention programs aimed at improving eye care for diabetic persons not only result in substantial federal budgetary savings but are highly cost-effective health investments for society. Ophthalmologic screening for diabetic persons is more cost-effective than many routinely provided health interventions. Because diabetic eye disease is the leading cause of new cases of blindness among working-age Americans, these results support the widespread use of screening and treatment for diabetic eye disease.
从健康保险公司的角度确定通过眼科筛查和治疗来预防糖尿病患者视力丧失的成本，并计算这些干预措施与其他医疗干预措施相比的成本效益。
计算机建模，纳入基于人群的流行病学研究和多中心临床试验的数据。使用了蒙特卡洛模拟，并结合了成本节约的敏感性分析和现值分析。
糖尿病患者眼部疾病的筛查和治疗每挽救一个质量调整生命年（QALY）的成本为3190美元。这个平均成本是一个加权平均值（基于疾病患病率），是在胰岛素依赖型糖尿病患者（每QALY 1996美元）、使用胰岛素进行血糖控制的非胰岛素依赖型糖尿病（NIDDM）患者（每QALY 2933美元）以及不使用胰岛素进行血糖控制的NIDDM患者（每QALY 3530美元）中检测和治疗糖尿病眼病的成本效益。
我们的分析表明，旨在改善糖尿病患者眼部护理的预防项目不仅能为联邦预算节省大量资金，而且对社会来说是极具成本效益的健康投资。糖尿病患者的眼科筛查比许多常规提供的健康干预措施更具成本效益。由于糖尿病眼病是美国工作年龄人群中新发失明病例的主要原因，这些结果支持广泛开展糖尿病眼病的筛查和治疗。
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