The impact of anchor point on utilities for 5 common ophthalmic diseases.
The impact of anchor point on utilities for 5 common ophthalmic diseases.
复制标题
锚点对 5 种常见眼科疾病效用的影响。
DOI：
10.1016/j.ophtha.2007.06.008
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发表时间：
2008
期刊：
影响因子：
13.7
通讯作者：
Gordon,MaeO
中科院分区：
文献类型：
--
作者：
Lee,BryanS;Kymes,StevenM;NeaseJr,RobertF;Sumner,Walton;Siegfried,CarlaJ;Gordon,MaeO
目的 为 5 种常见眼病引出完美健康和完美视力量表的效用。设计横断面观察性偏好研究。参与者我们纳入了 434 名患者：58 名糖尿病视网膜病变患者、99 名青光眼患者、44 名年龄相关性黄斑变性 (AMD) 患者、124 名白内障患者； 109 患有屈光不正。测试使用基于计算机的偏好评估访谈平台估计标准赌博效用。主要结果衡量标准赌博效用，一种生活质量衡量标准，检查是否愿意接受死亡或单眼失明风险以换取完美健康或完美视力。结果使用标准政策量表，其中健康相当于死亡为 0，完美健康为 1，患有无症状糖尿病视网膜病变的参与者效用为0.93。相比之下，有症状的糖尿病患者的效用进一步损失了 0.14。无症状青光眼参与者的效用为 0.92，早期视野丧失降低了 0.03，中心视野丧失进一步降低了 0.03。眼视力≥20/100 的 AMD 参与者报告效用为 0.89，而 AMD 更严重的参与者报告效用为 0.76。然而，临床白内障混浊评分和屈光不正均与实用性无关。对年龄和合并症的调整并没有改变这些关系。对于相同的参与者，用不同锚点测量的效用（单眼失明为 0，完美视力为 1）较低，尤其是在疾病严重程度增加的参与者中。在这种完美视力-失明量表和完美健康-死亡量表上评估的效用之间的差异范围从严重屈光不正患者的0.04到有症状的糖尿病患者的0.19和严重AMD的0.37。结论本文从先前未报告的434名患者样本中得出了具有不同定位点的效用。较低的效用分数通常意味着成功治疗或预防疾病带来的更大益处，但从传统政策量表转换到完美视力量表也始终会导致较低的分数。由于大多数先前的眼科研究都使用完美视力作为上锚，因此所得的效用可能不准确。
PURPOSETo elicit utilities on a perfect health and perfect vision scale for 5 common eye diseases.DESIGNCross-sectional observational preference study.PARTICIPANTSWe included 434 patients: 58 with diabetic retinopathy, 99 with glaucoma, 44 with age-related macular degeneration (AMD), 124 with cataract; 109 with refractive error.TESTINGStandard gamble utilities were estimated using a computer-based preference assessment interview platform.MAIN OUTCOME MEASURESStandard gamble utilities, a quality-of-life measure that examines the willingness to accept a risk of death or unilateral blindness in return for perfect health or perfect vision.RESULTSUsing the standard policy scale, where health equivalent to death is 0 and perfect health is 1, participants with asymptomatic diabetic retinopathy had a utility of 0.93. By comparison, symptomatic diabetics had a further utility loss of 0.14. Asymptomatic glaucoma participants had a utility of 0.92 with a decrease of 0.03 for early field loss and a further decrease of 0.03 with central field loss. Participants with AMD who had ≥20/100 better-eye visual acuity reported a utility of 0.89, whereas those with more severe AMD reported 0.76. However, neither clinical cataract opacity score nor refractive error correlated with utility. Adjustment for age and comorbidity did not alter these relationships. For the same participants, utilities measured with different anchor points—monocular blindness as 0 and perfect vision as 1—were lower, especially among participants with increased disease severity. The difference between utility assessed on this perfect vision–blindness scale and the perfect health–death scale ranged from 0.04 for those with severe refractive error to 0.19 for symptomatic diabetics and 0.37 for those with severe AMD.CONCLUSIONSThis paper elicits utilities with different anchor points from a previously unreported sample of 434 patients. Lower utility scores normally imply greater benefit with successful treatment or prevention of disease, but switching from the conventional policy scale to the perfect vision scale also consistently results in lower scores. Because most previous ophthalmic studies have used perfect vision as the upper anchor, the resulting utilities may not have been accurate.