Cost-effectiveness of glycemic control and ophthalmological care in diabetic retinopathy.
OBJECTIVE
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 euros by providing ophthalmological care and 50479 euros 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.
Polak
B C P
BC
Department of Ophthalmology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. bcp.polak@vumc.nl
Crijns
H
H
Casparie
A F
AF
Niessen
L W
LW
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D018450:Disease Progression; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000517:prevention & control*; D008390:Markov Chains; D008875:Middle Aged; D009313:National Health Programs; D009426:Netherlands; D009887:Ophthalmoscopy / Q000191:economics / Q000706:statistics & numerical data; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years
D006442:Glycated Hemoglobin