Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery
Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery
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DOI：
10.4103/0301-4738.162600
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发表时间：
2015-06-01
影响因子：
3.1
通讯作者：
Grover, Shivani
中科院分区：
文献类型：
--
作者：
Khan, Ashiya;Amitava, Abadan Khan;Grover, Shivani
背景：成本效益分析应持续评估相互竞争的医疗保健选择，特别是在像白内障手术这样的大容量环境中。目的：比较超声乳化术(PE)与人工小切口白内障手术(MSICS)的成本-效果。地点和设计：前瞻性随机对照试验。三级护理医院环境。对象和方法：前瞻性纳入52例年龄相关性白内障患者，随机分为PE组和MSICS组。统计手术前后的LogMAR视力(VA)、视功能-14(VF-14)评分及其质量调整寿命年(QALY)，并计算其变化。这些除以手术中发生的总成本，以计算和比较成本效益和成本效用。手术时间也进行了比较。统计分析：两组比较采用t检验。重要性设定在P<；0.05；95%可信区间(CI)，在适当的地方引用。结果：MSICS组和PE组在LogMARVA0.03[-0.05-0.111]、VF-14评分(7.92[-1.03-16.861)和QALYs(1.14[-0.89-3.161])的变化(平均值[95%CI]的差异)方面均有统计学意义。然而，由于成本显著较低(INR 3228[2700-3756])，MSICS更具成本效益，具有更高的成本效用价值。MSICS也明显快于PE(10.58min[6.85~14.301])。结论：与PE相比，MSICS提供了类似的视力和QALY改善，但所需时间更少，而且显著更具成本效益。在我国，政府加大对MSICS的推动和渗透力度是合理的。
Context: Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Statistical Analysis Used: Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Results: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [-0.05-0.111), VF-14 score (7.92 [-1.03-16.861) and QALYs (1.14 [-0.89-3.161). However, with significantly lower costs (INR 3228 [2700-3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.301) than PE. Conclusions: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.