A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities.
A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities.
复制标题
在非裔美国人社区中使用 SD-OCT 进行预计青光眼筛查后视野结果的比较有效性分析。
DOI：
10.1167/iovs.14-14014
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发表时间：
2014
影响因子：
4.4
通讯作者：
Cioffi,GeorgeA
中科院分区：
文献类型：
--
作者：
Blumberg,DanaM;Vaswani,Reena;Nong,Eva;Al-Aswad,Lama;Cioffi,GeorgeA
目的：评估使用光谱域光学相干断层扫描（SD-OCT）对非裔美国人群体进行社区青光眼筛查对视觉功能的影响。方法：使用Monte Carlo微观模拟模型，10年的时间范围，我们分析了SD-OCT筛查对非裔美国人人群视野结果的有效性，这些人不寻求以办公室为基础的护理。结果包括视野严重程度分类、质量调整生命年和直接医疗费用。假设随访率为60%，筛查将未确诊青光眼的患病率从75%降至38%，并将青光眼患者严重视野丧失的患病率从29.1%降至23.9%。相反，筛查使青光眼患者轻度视野丧失的患病率从9.2%增加到18.7%。从最初的筛查到确认性眼科检查，筛查项目（“仅筛查”）每个筛查个体的费用为98美元，每个青光眼新诊断为2561美元。当考虑到最初的筛选，通过最终的治疗成本，筛选程序（“筛选和治疗”）有一个平均每年的成本分别为79美元和2138美元，在10年的时间内。通过筛查获得的一个质量调整生命年（QALY）的成本，包括管理和治疗，与机会性病例发现相比，从46，416美元到67，813美元不等。结论：我们的研究结果表明，社区SD-OCT筛查在非洲裔美国人的人口将尽量减少青光眼相关的视觉发病率。理想情况下，通过改善药物依从性和改善随访依从性来最大限度地提高治疗效果的策略应在制定筛查计划之前确定并实施。
Purpose.: To assess the impact on visual function of community glaucoma screening in an African American population using spectral-domain optical coherence tomography (SD-OCT).Methods.: Using a Monte Carlo microsimulation model with a 10-year time horizon, we analyzed the efficacy of SD-OCT screening on visual field outcomes in a population of African Americans who are not otherwise seeking office-based care. Outcomes included classification of visual field severity, quality-adjusted life years, and direct health care costs.Results.: Assuming a 60% follow-up rate, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%, and decreased the prevalence of severe visual field loss in patients with glaucoma from 29.1% to 23.9%. Conversely, screening increased the prevalence of mild visual field loss in patients with glaucoma from 9.2% to 18.7%. From initial screening through confirmatory eye examination, the screening program (“screen only”) cost $98 per screened individual, and $2561 per new diagnosis of glaucoma. When considering the costs of initial screening though the resultant treatment, the screening program (“screen and treat”) had an average annual cost of $79 and $2138, respectively, over a 10-year time period. The cost of one quality-adjusted life year (QALY) gained by screening, including management and treatment, in comparison with opportunistic case finding, ranged from $46,416 to $67,813.Conclusions.: Our findings suggest that community SD-OCT screening in an African American population will minimize glaucoma-related visual morbidity. Ideally, strategies to maximize treatment efficacy through improved medication adherence and improved compliance with follow-up should be identified and implemented before instituting a screening program.