Cost-Effectiveness of Presbyopia Correction Among Seven Strategies of Bilateral Cataract Surgery Based on a Prospective Single-Blind Two-Center Trial in China.
Cost-Effectiveness of Presbyopia Correction Among Seven Strategies of Bilateral Cataract Surgery Based on a Prospective Single-Blind Two-Center Trial in China.
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DOI：
10.1007/s40123-022-00562-3
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发表时间：
2022-12
影响因子：
3.3
通讯作者：
Qi, Hong
中科院分区：
文献类型：
--
作者：
Lan, Qianqian;Liu, Yiyun;Xu, Fan;Li, Min;Li, Yaxin;Yang, Tingting;Sun, Tong;Yao, Gang;Ma, Baikai;Tao, Liyuan;Xiao, Xin;Feng, Xing Lin;Zeng, Siming;Qi, Hong
关键词：
本研究的目的是探索一种对双侧白内障手术不同策略中老花眼矫正成本效果进行排名的方法，为医疗政策制定者合理利用资源和外科医生定制患者管理提供参考。基于前瞻性单盲两中心临床试验的成本效益分析包括双侧白内障手术的七种策略：单焦点、单视、衍射双焦点、混合、折射双焦点、三焦点和扩展景深（EDOF）策略。根据客观眼镜独立率（以下简称“率”，一种新指标，定义为双眼未矫正远视力、中视力和近视力均优于 0.1 logMAR（最小分辨率对数）的患者比例）、成本、平均成本效益比（ACER，$/1% 比率）和增量成本效益比（ICER，$/1% 增量比率）来估计有效性。在 194 名参与者（388 只眼睛）中，三焦点策略取得了最高的成功率 [93.10%（95% 置信区间 (CI) 83.8–102.35%）]。屈光双焦点策略的 ACER 最低 [45.54 美元/1% 比率 (95% CI 34.57–56.50)]，其次是混合 [59.10 美元/1% 比率 (95% CI 31.72–86.48)]，衍射双焦点 [69.06 美元/1% 比率 (95% CI 31.72–86.48)] 30.89–107.21)]、EDOF [72.85 美元/1% 率 (95% CI 52.02–93.70)]、三焦点 [93.01 美元/1% 率 (95% CI 83.23–102.79)]、单视 [136.83 美元/1% 率 (95% CI − 55.40 至329.14)] 和单焦点 [264.45 美元/1% 率 (95% CI - 97.45 至 626.55)] 策略。与屈光双焦点策略相比，在中国2021年人均可支配收入每10%增量的一倍和三倍的支付意愿门槛下，三焦点策略（ICER $289.74/1%增量）非常划算和划算的概率分别为81.7%和93.2%。根据客观眼镜独立率，使用 ACER 和 ICER 进行成本效益分析，是确定白内障手术中高成本效益的老花眼矫正策略的有用工具，用于临床和政策决策。临床试验.gov (NCT04265846)。在线版本包含可在 10.1007/s40123-022-00562-3 获取的补充材料。
The aim of this study was to explore a method to rank the cost-effectiveness of presbyopia correction in diverse strategies of bilateral cataract surgery to provide references for healthcare policymakers in rationalizing resource utilization and surgeons in customizing patient management. The cost-effectiveness analysis based on a prospective single-blind two-center clinical trial included seven strategies in bilateral cataract surgery: monofocal, monovision, diffractive bifocal, blended, refractive bifocal, trifocal, and extended depth of focus (EDOF) strategies. The effectiveness according to the objective spectacle independence rate (hereafter “rate”, a novel indicator defined as the proportion of patients with binocular uncorrected distance, intermediate and near visual acuity all better than 0.1 logMAR, logarithm of the minimum angle of resolution), costs, average cost-effectiveness ratios (ACERs, $/1% rate), and incremental cost-effectiveness ratios (ICERs, $/1% incremental rate) were estimated. In 194 participants (388 eyes), the trifocal strategy achieved the highest rate [93.10% (95% confidence interval (CI) 83.8–102.35%)]. The refractive bifocal strategy had the minimum ACER [$45.54/1% rate (95% CI 34.57–56.50)], followed by the blended [$59.10/1% rate (95% CI 31.72–86.48)], diffractive bifocal [$69.06/1% rate (95% CI 30.89–107.21)], EDOF [$72.85/1% rate (95% CI 52.02–93.70)], trifocal [$93.01/1% rate (95% CI 83.23–102.79)], monovision [$136.83/1% rate (95% CI − 55.40 to 329.14)], and monofocal [$264.45/1% rate (95% CI − 97.45 to 626.55)] strategies. Compared with the refractive bifocal strategy, the probabilities that the trifocal strategy (ICER $289.74/1% incremental rate) is very cost-effective and cost-effective were 81.7% and 93.2%, respectively, at the wiliness-to-pay threshold of one and three times China’s annual disposable income per capita in 2021 per 10% incremental rates. Cost-effectiveness analysis with ACER and ICER according to objective spectacle independence rate is a helpful tool to identify highly cost-effective presbyopia-correcting strategies in cataract surgery for clinical and policy decisions. Clinicaltrials.gov (NCT04265846). The online version contains supplementary material available at 10.1007/s40123-022-00562-3.
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