| Budget Amount *help |
¥1,600,000 (Direct Cost: ¥1,600,000)
Fiscal Year 1999: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 1998: ¥1,000,000 (Direct Cost: ¥1,000,000)
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| Research Abstract |
( 1 ) Cost utility analysis
To assess the efficiency of the periodic examinations of detecting diabetic retinopathy, a Markov decision analytic model was constructed to compare four detecting strategies : 6-, 12-, 24-, 36-month interval screenings. The clinical effect on quality of life was expressed as quality-adjusted life years (QALYs). The costs were estimated from medical charge lists of the health insurance system in Japan. Our model showed that screening strategies would reduce visual loss and improve quality of life in individuals and that the incremental cost-effectiveness ratio of 6-month interval strategy, 4,571,800 yen/QALYs, would be very high compared with 12-month interval strategy, 662,100 yen/QALYs. The estimation not only from insurer's viewpoint but also from societal viewpoint is necessary to the appropriate evaluation of the efficiency.
( 2 ) Subjective health values of diabetic patients
We examined preferences for current health states in hospitalized patients with d
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iabetes using the rating scale (RS) and the standard gamble (SG), and evaluated the relation between their utility values and the other characteristics. Age and diabetes duration were related to the RS scores. Diabetic states such as glycosylated hemoglobin levels, diabetic complications and daily insulin injections did not influence both the RS scores and the SG scores. The individuals who desired to extend their life rather than to relieve pain provided significant higher RS scores than those who did not desire. Of personality factors, extracted from personality questionnaires by factor analysis, the "steadiness" correlated modestly and "tendency to give up" correlated inversely with the SG scores. Current subjective health values among diabetic patients varied widely and did not relate well to their diabetic states. In clinical practice of diabetes, not only objective clinical indicators but also subjective health values for diabetic states should be fully incorporated into the process of clinical decision making. Less
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