Cost Utility Analysis of Screening for Diabetic Retinopathy by a Computerized Simulation Model

（1）成本效用分析为评价糖尿病视网膜病变定期检查的有效性，建立了马尔可夫决策分析模型，比较了6、12、24、36个月间隔筛查四种检查策略的效果。对生活质量的临床影响表示为质量调整生命年（Qs）。这些费用是根据日本健康保险系统的医疗费用清单估算的。我们的模型显示，筛查策略可以减少视力丧失并改善个人的生活质量，6个月间隔策略的增量成本效益比为4，571，800日元/QDs，与12个月间隔策略的增量成本效益比662，100日元/QDs相比，增量成本效益比非常高。为了正确评价保险公司的效率，不仅需要从保险公司的角度进行评估，而且需要从社会的角度进行评估。（2）糖尿病患者的主观健康价值我们调查了住院糖尿病患者对当前健康状况的偏好， ...更多信息 采用量表（RS）和标准博弈（SG）进行分析，并评价其效用值与其他特征的关系。年龄和糖尿病病程与RS评分相关。糖尿病状态如糖化血红蛋白水平、糖尿病并发症和每日胰岛素注射不影响RS评分和SG评分。希望延长寿命而不是缓解疼痛的个体比不希望延长寿命的个体提供了显著更高的RS评分。在人格因素中，以因子分析法提取的人格问卷中，“稳定性”与SG得分呈中度相关，“放弃倾向”与SG得分呈负相关。糖尿病患者目前的主观健康值差异很大，并没有很好地与他们的糖尿病状态。在糖尿病的临床实践中，不仅要将客观的临床指标，而且要将糖尿病状态的主观健康价值充分纳入临床决策过程。少

( 1 ) Cost utility analysisTo assess the efficiency of the periodic examinations of detecting diabetic retinopathy, a Markov decision analytic model was constructed to compare four detecting strategies : 6-, 12-, 24-, 36-month interval screenings. The clinical effect on quality of life was expressed as quality-adjusted life years (QALYs). The costs were estimated from medical charge lists of the health insurance system in Japan. Our model showed that screening strategies would reduce visual loss and improve quality of life in individuals and that the incremental cost-effectiveness ratio of 6-month interval strategy, 4,571,800 yen/QALYs, would be very high compared with 12-month interval strategy, 662,100 yen/QALYs. The estimation not only from insurer's viewpoint but also from societal viewpoint is necessary to the appropriate evaluation of the efficiency.( 2 ) Subjective health values of diabetic patientsWe examined preferences for current health states in hospitalized patients with d … More iabetes using the rating scale (RS) and the standard gamble (SG), and evaluated the relation between their utility values and the other characteristics. Age and diabetes duration were related to the RS scores. Diabetic states such as glycosylated hemoglobin levels, diabetic complications and daily insulin injections did not influence both the RS scores and the SG scores. The individuals who desired to extend their life rather than to relieve pain provided significant higher RS scores than those who did not desire. Of personality factors, extracted from personality questionnaires by factor analysis, the "steadiness" correlated modestly and "tendency to give up" correlated inversely with the SG scores. Current subjective health values among diabetic patients varied widely and did not relate well to their diabetic states. In clinical practice of diabetes, not only objective clinical indicators but also subjective health values for diabetic states should be fully incorporated into the process of clinical decision making. Less