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Diabetes Care and Health Systems |

Cost-Effectiveness of Detecting and Treating Diabetic Retinopathy

Jonathan C. Javitt, MD, MPH; and Lloyd Paul Aiello, MD PhD
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From Georgetown University Medical Center, Washington, D.C., and the Joslin Diabetes Center, Boston, Massachusetts. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Acknowledgments: The authors thank Yen Pin Chiang, PhD, and Joseph Canner, MS, for technical assistance. Grant Support: In part by grants RO1-EYO8805 and R21-EY07744 from the National Eye Institute, National Institutes of Health, Bethesda, Maryland, and an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. Requests for Reprints: Jonathan C. Javitt, MD, MPH, Center for Sight, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007. Current Author Addresses: Dr. Javitt, Center for Sight, Georgetown University Medical Center. 3800 Reservoir Road, NW, Washington, DC 20007.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_2):164-169. doi:10.7326/0003-4819-124-1_Part_2-199601011-00017
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Objective: 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.

Design: 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.

Results: 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 of 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).

Conclusions: 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.


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Figure 1.
Sensitivity analysis for the cost-effectiveness of ophthalmologic screening and treatment of retinopathy in insulin-dependent (type I) and non–insulin-dependent diabetes mellitus (type II).

Assumptions used in the text (74.4% “well-adjusted” patients equals 0.48 QALYs; 25.6% “poorly adjusted” patients equals 0.36 QALYs) represent an x-axis value of 0.45. All costs are expressed in 1990 U.S. dollars.

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