Cost-effectiveness of glycemic control and ophthalmological care in diabetic retinopathy

Aims: Glycemic control and ophthalmological care are known to significantly diminish the risk of visual impairment and blindness by diabetic retinopathy (DRP). The (cost-)effectiveness of both strategies was studied to highlight their benefits for patients and care providers. Methods: A computer ana...

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Bibliographic Details
Published in:Health policy (Amsterdam) 2003-04, Vol.64 (1), p.89-97
Main Authors: Polak, B.C.P., Crijns, H., Casparie, A.F., Niessen, L.W.
Format: Article
Language:English
Subjects:
Adult
Aged
Cohort Studies
Computer Simulation
Cost-Benefit Analysis
Cost-effectiveness
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - economics
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - economics
Diabetic retinopathy
Diabetic Retinopathy - diagnosis
Diabetic Retinopathy - economics
Diabetic Retinopathy - prevention & control
Disease Progression
Glycated Hemoglobin A - analysis
Glycemic control
Health administration
Humans
Hyperglycemia - complications
Hyperglycemia - prevention & control
Markov Chains
Middle Aged
National Health Programs
Netherlands
Ophthalmological care
Ophthalmoscopy - economics
Ophthalmoscopy - utilization
Patient Compliance
Quality-Adjusted Life Years
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Summary:Aims: Glycemic control and ophthalmological care are known to significantly diminish the risk of visual impairment and blindness by diabetic retinopathy (DRP). The (cost-)effectiveness of both strategies was studied to highlight their benefits for patients and care providers. Methods: A computer analysis was developed, following the progression of DRP and the effectiveness of metabolic control and ophthalmological care continuously and individually in cohorts of type I and type II DM patients with divergent degrees of compliance. Costs relate to present medical charges in the Netherlands. Results: Intensive glycemic control shortens the duration of blindness in a type I DM patient by 0.76 years, intensive ophthalmological care by 0.53 years. One year sight gain may cost €1126 by providing ophthalmological care and €50 479 by glycemic control. The duration of blindness drops in a type II DM patient by 0.48 and 0.13 years, respectively, whereas the effectiveness decreases as the age of onset of DM rises. Conclusions: The vast majority of diabetic patients benefits from both intensive glycemic control and intensive ophthalmological care, but these cost-effective interventions which are not only complementary, but also substitute each other, require lasting, full compliance by all parties concerned.
ISSN:0168-8510
1872-6054
DOI:10.1016/S0168-8510(02)00143-4