TY  - JOUR
T1  - HOw often should patients with diabetes be screened for retinopathy?—reply
AU  - Fontanarosa PB, Vijan S, Hofer TP, Hayward RA
Y1  - 2000/07/26
N1  - 10.1001/jama.284.4.436
JO  - JAMA
SP  - 437
EP  - 439
VL  - 284
IS  - 4
N2  - 
We are perplexed by Dr Javitt's criticism of our blindness utility measure,
since our base model used the same utility value (0.69) that he and his colleagues
used in their most recent model.1- 2
However, we agree that estimates of utility of visual impairment vary substantially,
and Dr Brown and colleagues cite interesting recent articles on this topic.
Still, although lower utility measures would influence the estimates, especially
for high-risk patients (whom we already agree should be screened annually),
no assumptions in our sensitivity analyses had a major effect on the cost-effectiveness
for low-risk patients, even if we set the utility value to 0. In contrast,
the inclusion of any degree of dislike of retinal examination (such as a disutility
value of 0.0014, reflecting one half day lost per year) makes annual screening
very unfavorable for most patients. The important result of our study is the
stable and robust finding of minimal benefit of annual vs every 2- to 3-year
screening for low-risk individuals, not conclusions about average cost-effectiveness
for the overall population. None of the concerns raised in the letters change
this conclusion.

SN  - 0098-7484
M3  - doi: 10.1001/jama.284.4.436
UR  - http://dx.doi.org/10.1001/jama.284.4.436
ER  -