The Increased Cost of Medical Services for People Diagnosed With Primary Open-Angle Glaucoma: A Decision Analytic Approach
The Increased Cost of Medical Services for People Diagnosed With Primary Open-Angle Glaucoma: A Decision Analytic Approach
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DOI：
10.1016/j.ajo.2010.01.037
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发表时间：
2010-07-01
影响因子：
4.2
通讯作者：
Fain, Joel
中科院分区：
文献类型：
--
作者：
Kymes, Steven M.;Plotzke, Michael R.;Fain, Joel
目的：在美国，青光眼占所有失明病例的 11% 以上，但关于经济影响的研究很少。我们研究了原发性开角型青光眼的增量成本，考虑了青光眼一生中的视觉和非视觉医疗成本。设计：一种决策分析方法，从付款人的角度进行微观模拟估计。方法：我们构建了一个马尔可夫模型来复制新诊断青光眼患者剩余生命中的健康事件。该组的成本与没有青光眼的对照组的估计成本进行了比较。没有考虑视力障碍发生前青光眼的治疗费用（包括药物）。该模型填充了根据 Medicare 索赔数据（1999 年至 2005 年）估计的概率数据。非眼科药物和疗养院使用费用根据加州医疗保险索赔估算，所有其他费用根据医疗保险索赔数据估算。结果：我们发现青光眼患者和对照组之间的共病发生率和医疗服务使用情况存在一定差异。在预期寿命期间，原发性开角型青光眼患者的护理费用比非原发性开角型青光眼患者高出 1688 美元，即每年约 137 美元。结论：在 Medicare 受益人中，未发现青光眼诊断与出现视力障碍之前发生合并症的显着风险相关。有必要进行进一步的研究，以考虑青光眼对生活质量的影响，以及本基于索赔的分析中未涵盖的身体和视觉功能方面。 （美国眼科杂志 2010 年；150:74-81。(C) 2010 年，Elsevier Inc. 保留所有权利。）
PURPOSE: Glaucoma accounts for more than 11% of all cases of blindness in the United States, but there have been few studies of economic impact. We examine incremental cost of primary open-angle glaucoma considering both visual and nonvisual medical costs over a lifetime of glaucoma.DESIGN: A decision analytic approach taking the payor's perspective with microsimulation estimation.METHODS: We constructed a Markov model to replicate health events over the remaining lifetime of someone newly diagnosed with glaucoma. Costs of this group were compared with those estimated for a control group without glaucoma. The cost of management of glaucoma (including medications) before the onset of visual impairment was not considered. The model was populated with probability data estimated from Medicare claims data (1999 through 2005). Cost of nonocular medications and nursing home use was estimated from California Medicare claims, and all other costs were estimated from Medicare claims data.RESULTS: We found modest differences in the incidence of comorbid conditions and health service use between people with glaucoma and the control group. Over their expected lifetime, the cost of care for people with primary open-angle glaucoma was higher than that of people without primary open-angle glaucoma by $1688 or approximately $137 per year.CONCLUSIONS: Among Medicare beneficiaries, glaucoma diagnosis not found to be associated with significant risk of comorbidities before development of visual impairment. Further study is necessary to consider the impact of glaucoma on quality of life, as well as aspects of physical and visual function not captured in this claims-based analysis. (Am J Ophthalmol 2010;150:74-81. (C) 2010 by Elsevier Inc. All rights reserved.)