A systems modelling approach for the prevention and treatment of diabetic retinopathy

Diabetic patients may suffer from a number of long-term complications. One such complication is the onset of diabetic retinopathy, which damages the eyes and can lead to blindness. We describe the use of a systems modelling approach for the progression of diabetic retinopathy that has been used for cost-effectiveness evaluations of various prevention and patient care options. The adopted framework incorporates retinopathy risk groupings, created using classification and regression tree (CART) analysis, which are then fed into a developed simulation model, at the level of individual diabetic patients. A multidisciplinary task group, comprising of clinicians and health care modellers, guided the necessary modular development involving the definition of risk groups in the community, natural history of diabetic retinopathy, and options for early detection and treatment. Data has been taken from a prospective Wellcome Diabetes Study at the Diabetes Unit, King Edward Memorial Hospital, Pune, India. India has the highest number of diabetic patients in any one country, approximately 25 million in 2000, and this number is predicted to rise to 57 million by the year 2025. (C) 2002 Elsevier Science B.V. All rights reserved.