Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis.
Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis.
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DOI：
10.1016/j.ophtha.2014.04.022
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发表时间：
2014-10
期刊：
影响因子：
13.7
通讯作者：
Frick, Kevin D.
中科院分区：
文献类型：
--
作者：
Sugar, Elizabeth A.;Holbrook, Janet T.;Kempen, John H.;Burke, Alyce E.;Drye, Lea T.;Thorne, Jennifer E.;Louis, Thomas A.;Jabs, Douglas A.;Altaweel, Michael M.;Frick, Kevin D.
评估氟西诺酮植入物与全身治疗治疗非感染性中、后、全葡萄膜炎的3年增量成本-效果。随机、对照、临床试验。多中心葡萄膜炎类固醇治疗试验纳入了活动性或近期活动性中间、后膜炎或全葡萄膜炎患者。随机化后3年内的成本和健康效用数据每隔6个月评估一次。由于植入物的前期成本较大，分析按随机化时的疾病侧位进行分层（31例单侧vs 224例双侧）。主要结果是3年内的增量成本-效果比（ICER）：成本差异（以美元计）与质量调整生命年（QALYs）变化差异的比率。包括药物、手术、住院和常规程序（如全身治疗的实验室监测）的费用。qaly计算为3年随访期间EQ-5D评分的加权平均值。由于种植体治疗的高成本（Difference implant - Systemic [Δ]: 16,900美元，p<0.001）和QALYs的温和增长（Δ = 0.057, p = 0.22），双侧疾病的三年ICER为297,800美元/QALY。ICER在50,000美元/QALY和100,000美元/QALY阈值下具有成本效益的概率分别为0.003和0.04。单侧疾病的ICER更有利，3年时为41,200美元/QALY，这是由于两种疗法之间的成本差异较小（Δ = 5300美元，p = 0.44），而植入QALY的收益更大（Δ = 0.130, p = 0.12）。ICER在50,000美元/QALY和100,000美元/QALY阈值下具有成本效益的概率分别为0.53和0.74。与全身治疗相比，氟西诺酮植入治疗对单侧中间、后或全葡萄膜炎患者具有合理的成本效益，但对双侧疾病患者则不适用。这些结果不适用于当全身治疗失败或有禁忌症时使用植入治疗。如果种植体效果的持续时间明显超过3年，或者治疗价格发生重大变化，则需要重新评估种植体与全身治疗的成本效益。
To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of non-infectious intermediate, posterior, and panuveitis. Randomized, controlled, clinical trial. Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial. Data on cost and health-utility during 3 years post-randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) due to the large upfront cost of the implant. The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States Dollars) to the difference in change in quality adjusted life years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g. lab monitoring for systemic therapy) were included. QALYs were computed as a weighted average of EQ-5D scores over the 3 years of follow-up. The ICER at three years was $297,800/QALY for bilateral disease, driven by the high cost of implant therapy (Difference Implant – Systemic [Δ]: $16,900, p<0.001) and the modest gains in QALYs (Δ = 0.057, p = 0.22). The probability of the ICER being cost-effective at thresholds of $50,000/QALY and $100,000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, $41,200/QALY at 3 years, due to a smaller difference in cost between the two therapies (Δ = $5,300, p = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130, p = 0.12). The probability of the ICER being cost-effective at thresholds of $50,000/QALY and $100,000/QALY was 0.53 and 0.74, respectively. Fluocinolone acetonide implant therapy was reasonably cost-effective as compared to systemic therapy for individuals with unilateral intermediate, posterior or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove substantially longer than three years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be re-evaluated.
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影响因子：
1.8
作者：
Kempen, John H.;Daniel, Ebenezer;Suhler, Eric B.
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