The goal of value-based medicine analyses: comparability. The case for neovascular macular degeneration.
The goal of value-based medicine analyses: comparability. The case for neovascular macular degeneration.
复制标题
基于价值的医学分析的目标：可比性。
DOI：
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Sanjay Sharma
中科院分区：
文献类型：
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作者：
Gary C. Brown;Melissa M. Brown;H. Brown;S. Kindermann;Sanjay Sharma
目的
评价同行评审文献中评估新生血管性年龄相关性黄斑变性（ARMD）干预相关（1）患者价值和（2）成本效用（成本-效果）的文章的可比性。
方法
使用关键词成本效用、成本效益、价值、维替泊芬、哌加他尼、激光光凝、雷珠单抗和治疗，在美国国家医学图书馆数据库中检索了1600万篇同行评审文章。所有使用质量调整生命年结果的文章都在（1）生活质量改善百分比，（2）效用方法，（3）效用受访者，（4）包括的成本类型方面进行了研究（例如，直接医疗保健、直接非医疗保健、间接），（5）成本基础（例如，医疗保险，英国的国民健康服务），和（6）研究成本的角度（例如，政府，社会，第三方保险公司）。为了符合基于价值的医学分析的条件，必须使用相应干预措施所赋予的QURs结果来衡量患者价值。与基于价值的医学分析一样，必须利用基于患者的时间权衡效用分析，患者效用受访者是必要的，并使用直接医疗成本。
结果
在对新生血管性黄斑变性干预进行的21项成本效用分析中，15项（71%）符合基于价值的医学标准。其他6项（29%）不具有可比性，原因是（1）不同的效用方法，（2）不同的效用受访者，（3）不同的成本使用，（4）不同的成本基础，（5）不同的研究视角。在基于价值的医学研究中，激光光凝治疗经典中心凹下脉络膜新生血管的价值增加了4.4%（生活质量改善）。玻璃体内注射哌加他尼可使经典、最小经典和隐匿性中心凹下脉络膜新生血管的治疗价值增加5.9%（生活质量改善），而维替泊芬光动力疗法可使经典中心凹下脉络膜新生血管的治疗价值增加7.8%至10.7%。玻璃体内雷珠单抗治疗中心凹下隐匿性和最小经典中心凹下脉络膜新生血管的价值增加大于15%。
结论
大多数关于新生血管性黄斑变性干预的成本效用研究是基于价值的医学研究，因此具有可比性。对新生血管ARMD单药治疗的基于价值的分析证明了基于价值的医学在提高护理质量和同时最大限度地提高公共政策中医疗资源使用的功效方面的力量。基于价值的药物成本效用分析的可比性对整体实践标准和公共政策具有重要意义。采用以价值为基础的医学标准可以大大促进更高质量的护理目标，并最大限度地最佳利用医疗保健资金。
PURPOSE
To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD).
METHODS
A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used.
RESULTS
Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization.
CONCLUSIONS
The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds.
视网膜疾病患者效用评估的时间权衡技术的可靠性。
DOI：
10.1097/00132578-200207000-00025
发表时间：
2001
期刊：
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie
影响因子：
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作者：
H. Hollands;M. Lam;J. Pater;D. Albiani;G. Brown;M. Brown;A. Cruess;S. Sharma
通讯作者：
S. Sharma