Preventive Eye Care in People With Diabetes Is Cost-Saving to the Federal Government: Implications for health-care reform

  1. Sheldon Greenfield, MD
  1. Worthen Center for Eye Care Research, Center for Sight, Georgetown University Medical Center Washington, DC
  2. Wilmer Ophthalmalogical Institute, Johns Hopkins University Baltimore, Maryland
  3. Beetham Eye Institute, Joslin Diabetes Center Boston, Massachusetts
  4. Office of Biometry, National Eye Institute, National Institutes of Health Bethesda, Maryland
  5. Diabetes PORT Project, The Health Institute, New England Medical Center Boston, Massachusetts. Dr. Chiang is currently located at the Health Program, Office of Technology Assessment U.S. Congress, Washington, DC
  1. Address correspondence and reprint requests to Jonathan C. Javitt, MD, MPH, Center for Sight, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007.


OBJECTIVE Diabetic retinopathy, which leads to macular edema and retinal neovascularization, is the leading cause of blindness among working-age Americans. Previous research has demonstrated significant cost savings associated with detection of eye disease in Americans with type 1 diabetes. However, detection and treatment of eye disease among those with type II diabetes was previously thought not to be cost-saving. Our purpose was to estimate the current and potential federal savings resulting from the screening and treatment of retinopathy in patients with type II diabetes, based on recently availabledata concerning efficacy of treating both macular edema and neovascularization along withnew data on federal budgetary costs of blindness.

RESEARCH DESIGN AND METHODS We used computer modeling, incorporating data from population-based epidemiological studies and multicenter clinical trials. Monte Ciarlosimulation was used, combined with sensitivity analysis and present value analysis of cost savings.

RESULTS Screening and treatment for eye disease in patients with type II diabetes generates annual savings of $247.9 million to the federal budget and 53,986 person-years of sight, even at current suboptimal (60%) levels of care. If all patients with type II diabetes receive recommended care, the predicted net savings (discounted at 5%) exceeds $472.1 million and 94,304 person-years of sight. Nearly all savings areassociated with detection and treatment of diabetic macular edema. Enrolling each additional person with type II diabetes into currently recommended ophthalmological care resultsin an average net savings of $975/person, even if all costs of care are borne by the federal government.

CONCLUSIONS Our analysis indicates that prevention programs aimed at improving eye care for patients with diabetes not only reduce needless vision loss but also willprovide a financial return on the investment of public funds.

  • Received November 5, 1993.
  • Accepted February 17, 1994.
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