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1 January 1996 | Volume 124 Issue 1 Part 2 | Pages 164-169
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.
Author and Article Information
From Georgetown University Medical Center, Washington, D.C., and the Joslin Diabetes Center, Boston, Massachusetts.
DIABETES CARE AND HEALTH SYSTEMS
Cost-Effectiveness of Detecting and Treating Diabetic Retinopathy
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.
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