COST-EFFECTIVENESS OF STRATEGIES FOR DETECTING DIABETIC-RETINOPATHY
COST-EFFECTIVENESS OF STRATEGIES FOR DETECTING DIABETIC-RETINOPATHY
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DOI：
10.1097/00005650-199101000-00003
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发表时间：
1991-01-01
期刊：
影响因子：
3
通讯作者：
KLEIN, BEK
中科院分区：
文献类型：
--
作者：
DASBACH, EJ;FRYBACK, DG;KLEIN, BEK
已经开发了一个计算机模型，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。这个模型被用来评估每年两次和每年一次的筛查计划，包括检眼镜检查、用“非散瞳照相机”进行眼底照相和用“散瞳照相机”进行照相。“对三个亚群进行了计算，这些亚群由年轻发病的糖尿病患者（诊断时年龄< 30岁）组成，持续时间为5年或更长，老年发病的糖尿病患者（诊断时年龄大于或等于30岁）正在服用胰岛素，老年发病的糖尿病患者不服用胰岛素。人口特征是从一个良好的描述南部威斯康星州人口的数据是可用的，但计算机模型可能是专门为其他人群。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以通过避免失明成本来收回;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不能通过避免失明成本来收回。据估计，每年提供散瞳眼底摄影检查作为筛查计划，对1,000名糖尿病患者进行队列检查，这些患者来自确诊至少5年且目前未接受治疗的年轻发病人群，可能会在队列的一生中节省319视力年。该计划将在服用胰岛素的老年发病队列中节省62个视力年，在不服用胰岛素的老年发病人群中节省21个视力年（所有收益均以现值表示，年贴现率为5%）。其他计划在每个子人群中实现的储蓄略低。
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 < 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 populations. 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.