REPLY
Cost-Effectiveness of Detecting and Treating Diabetic Retinopathy
Jonathan C. Javitt, MD, MPH, and
Lloyd Paul Aiello, MD, PhD
1 December 1996 | Volume 125 Issue 11 | Page 939
IN RESPONSE:
We appreciate Dr. Lambert's interest in our work. However, contrary to his assertion, neither of the issues he raises limits the application of our study results to decision making.
Dr. Lambert challenges our assumption that persons with diabetes who lose their sight are as likely to be rehabilitated as visually disabled persons in the rest of the population. He suggests that loss of proprioception and touch sensation associated with diabetes might cause persons with diabetes to value their sight more highly than do those without the disease. Although he presents no data to support this proposition, we can see the logic in the argument. However, increasing the value in quality-adjusted years of life associated with vision in our model, as Dr. Lambert suggests, only increases the estimated cost-effectiveness of screening for and treating diabetic eye disease. This certainly does not limit the value of our study.
Dr. Lambert also infers that we subtracted the averted financial cost associated with blindness from the health care cost of delivering the intervention. We have not done so in this or any other article that addresses cost-effectiveness, and we agree that it would be improper to do so. We have previously discussed the cost savings associated with detecting and treating eye disease from the federal perspective; in that model we appropriately considered costs associated with blindness [1].
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Author and Article Information
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Georgetown University Medical Center, Washington, DC 20007.
Joslin Diabetes Center, Boston, MA 02215.
1. Javitt JC, Aiello LP, Ferris FL, Canner JK, Chiang YP, Greenfield SR. Preventive eye care in people with diabetes is cost-saving to the federal government: implications for health-care reform. Diabetes Care. 1994; 17:909-17.
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