0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Diabetes Care and Health Systems |

Cost-Effectiveness of Detecting and Treating Diabetic Retinopathy

Jonathan C. Javitt, MD, MPH; and Lloyd Paul Aiello, MD PhD
[+] Article and Author Information

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
Text Size: A A A

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.

Figures

Grahic Jump Location
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.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)