{"_buckets": {"deposit": "8af1f29a-ff34-407b-866c-0e90c2a07f96"}, "_deposit": {"id": "11287", "owners": [], "pid": {"revision_id": 0, "type": "depid", "value": "11287"}, "status": "published"}, "_oai": {"id": "oai:nagoya.repo.nii.ac.jp:00011287", "sets": ["1215"]}, "author_link": ["34194", "34195"], "item_1618209983323": {"attribute_name": "助成情報", "attribute_value_mlt": [{"subitem_award_numbers": {"subitem_award_number": "10672124", "subitem_award_uri": "https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-10672124"}, "subitem_award_titles": [{"subitem_award_title": "シミュレーションモデルを用いた糖尿病網膜症スクリーニングの費用効用分析", "subitem_award_title_language": "ja"}], "subitem_funder_identifiers": {"subitem_funder_identifier": "https://doi.org/10.13039/501100001691", "subitem_funder_identifier_type": "Crossref Funder"}, "subitem_funder_names": [{"subitem_funder_name": "日本学術振興会", "subitem_funder_name_language": "ja"}]}]}, "item_19_biblio_info_6": {"attribute_name": "書誌情報", "attribute_value_mlt": [{"bibliographicIssueDates": {"bibliographicIssueDate": "2000-03", "bibliographicIssueDateType": "Issued"}}]}, "item_19_description_4": {"attribute_name": "抄録", "attribute_value_mlt": [{"subitem_description": "1.シミュレーションモデルの開発:網膜症未発症,非増殖網膜症,増殖網膜症もしくは黄斑浮腫,高度視力障害,死亡の5つの健康状態を持つMarkov modelを基本構造とした糖尿病網膜症モデルを開発した.モデルに使用した年齢ごとの死亡率は厚生省第18回生命表を用い,各健康状態の推移確率や治療効果は,MEDLINEと医学中央雑誌を検索し内外の臨床研究を収集しそれらを基に推定した. 2.効用理論の評価:入院中の糖尿病患者を対象に,評点尺度法と基準的賭け法によって現在の自分自身の健康状態と,架空の健康状態である失明状態に対する効用値(患者の価値観や意向の指標)を測定した.同時に東大式エゴグラムと自記式の性格調査を実施し,効用値と臨床的な指標,自我状態,性格特性との関連を検討した.その結果,効用値は糖尿病状態を評価するために従来から使用されてきた臨床的な指標よりも,性格特性との関連が強いことが示された. 3.費用効用分析:開発したモデルと保険診療報酬点数を用いて費用効用分析を行った.その結果,36か月毎,24か月毎,12か月毎,6か月毎の QALY(quality-adjusted life year)はそれぞれ,14.11年,14.13年,14.15年,14.17年とスクリーニング間隔が短いほど長くなった.増分費用効果比 (incremental cost effectiveness ratio)は,6か月毎が4,571.8千円/QALYと,12か月毎の662.1千円/QALYに比較して高値となり,36か月毎は除外された.つまり6か月間隔のスクリーニング実施は,12か月間隔に比較してより多くの追加投資が必要と計算された.(数値は年率5%割引) 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