Cost-effectiveness of glaucoma interventions in Barbados and Ghana.
Cost-effectiveness of glaucoma interventions in Barbados and Ghana.
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DOI：
10.1097/opx.0b013e3181fc30f3
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发表时间：
2011-01
期刊：
影响因子：
--
通讯作者：
Rein DB
中科院分区：
文献类型：
--
作者：
Wittenborn JS;Rein DB
全世界90%以上的失明存在于发展中国家，但有关这些环境中的社会和经济负担以及治疗成本效益的信息往往有限或不存在。我们展示了使用计算机建模来模拟原发性开角型青光眼在高发病率的发展中国家人群中的当前和未来的流行病学、结果和治疗。修改了先前验证的视力模型，以模拟巴巴多斯青光眼的发病率进展和社会经济后果，巴巴多斯是流行病学数据的来源;加纳有类似的青光眼倾向，但社会经济发展水平较低。然后，我们评估了假设的病例发现和治疗方案的成本效益，包括美国指南级护理和一次性激光手术。巴巴多斯青光眼造成的社会和经济负担比加纳大。在巴巴多斯，人口筛查后再进行美国指导水平的护理似乎具有很高的成本效益。由于加纳人口年轻，死亡率较高，青光眼在加纳造成的视力损害和失明似乎少于巴巴多斯，因此人均残疾和生产力损失较低。在加纳，人口筛查或指南级治疗方案通常不具有成本效益，但相对于世卫组织愿意支付的阈值，用假设的一次性激光手术治疗自我转诊患者具有很高的成本效益。青光眼的社会和经济负担在更发达的国家更高，这是由于预期寿命增加，人口年龄分布更老，人均国内生产总值更高。同样，较低的死亡率和较高的人均国内生产总值增加了旨在减轻青光眼负担的筛查和治疗干预措施的相对成本效益。
More than 90% of blindness worldwide exists in the developing world, but information on the social and economic burden and the cost-effectiveness of treatment in these settings is often limited or nonexistent. We demonstrate the use of computer modeling to simulate the current and future epidemiology, outcomes, and treatment of primary open-angle glaucoma in high-incidence developing world populations. A previously validated vision model was modified to simulate the incidence progression and social and economic outcomes of glaucoma in Barbados, which was the source of epidemiology data; and Ghana, which has similar propensity for glaucoma but lower socioeconomic development. We then assessed the cost-effectiveness of hypothetical case-finding and treatment scenarios, including U.S. guideline-level care and one-time laser surgery. Barbados incurs relatively greater social and economic burden from glaucoma than Ghana. In Barbados, population screening followed by U.S. guideline levels of care appears to be highly cost-effective. Due to a younger population with higher mortality at younger ages, glaucoma appears to cause less visual impairment and blindness in Ghana than in Barbados, resulting in lower per capita disability and productivity losses. Population screening or guideline-level treatment scenarios were generally not cost-effective in Ghana, but treating self-referring patients with a hypothetical one-time laser surgery was highly cost-effective relative to WHO willingness to pay thresholds. The social and economic burden of glaucoma is higher in more developed nations due to increased life expectancy, an older population age profile, and higher per capita gross domestic product. Likewise, lower mortality rates and higher per capita gross domestic product increase the relative cost-effectiveness of screening and treatment interventions intended to mitigate glaucoma burden.