Cost-effectiveness of detecting and treating diabetic retinopathy

Ann Intern Med. 1996 Jan 1;124(1 Pt 2):164-9. doi: 10.7326/0003-4819-124-1_part_2-199601011-00017.


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 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age of Onset
  • Computer Simulation
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / economics*
  • Diabetic Retinopathy / prevention & control
  • Diabetic Retinopathy / therapy
  • Humans
  • Mass Screening / economics
  • Medicare
  • Population Surveillance
  • Program Evaluation
  • Quality-Adjusted Life Years
  • United States