Value-Based Medicine, Comparative Effectiveness, and Cost-effectiveness Analysis of Topical Cyclosporine for the Treatment of Dry Eye Syndrome
Value-Based Medicine, Comparative Effectiveness, and Cost-effectiveness Analysis of Topical Cyclosporine for the Treatment of Dry Eye Syndrome
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DOI：
10.1001/archophthalmol.2008.608
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发表时间：
2009-02-01
影响因子：
--
通讯作者：
Roth, Zachary
中科院分区：
文献类型：
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作者：
Brown, Melissa M.;Brown, Gary C.;Roth, Zachary
目的：评估比较有效性和成本效益0.05%外用环孢菌素乳剂（成本-效用）（Restasis; Allergan Inc，Irvine，加州）用于治疗对常规疗法无反应的中度至重度干眼症。数据来自2项多中心、随机、临床试验和食品药品监督管理局关于局部环孢素（0.05%）的文件，乳剂用于基于价值的医学分析中心。分析包括价值为基础的医学作为比较有效性分析和平均成本效用分析使用社会和第三方保险公司的成本perspectives.Main Outcome Measures：结果措施的比较有效性是质量调整生命年（QALY）增益和百分比的改善生活质量，和成本效益的成本效用比（CUR）使用美元每QALY。与局部润滑剂治疗相比，局部使用0.05%环孢霉素每年的价值增加（相对有效性）为0.0319 QALY，对于常规润滑剂治疗无效的中重度干眼症患者，平均生活质量改善4.3%。从社会角度来看，环孢素相对于溶媒治疗的增量CUR为34 953美元/QALY，从社会角度来看，平均CUR为11 199美元/QALY。第三方保险公司的增量CUR为37 179美元每QALY，而第三方保险公司的角度平均CUR为34 343美元每QALY.Conclusions：局部环孢素乳剂，0.05%，赋予相当大的患者价值，是一种具有成本效益的治疗中度至重度干眼症，是对常规治疗反应迟钝。
Objective: To assess the comparative effectiveness and cost-effectiveness (cost-utility) of a 0.05% emulsion of topical cyclosporine (Restasis; Allergan Inc, Irvine, California) for the treatment of moderate to severe dry eye syndrome that is unresponsive to conventional therapy.Methods: Data from 2 multicenter, randomized, clinical trials and Food and Drug Administration files for topical cyclosporine, 0.05%, emulsion were used in Center for Value-Based Medicine analyses. Analyses included value-based medicine as a comparative effectiveness analysis and average cost-utility analysis using societal and third-party insurer cost perspectives.Main Outcome Measures: Outcome measures of comparative effectiveness were quality-adjusted life-year (QALY) gain and percentage of improvement in quality of life, and for cost-effectiveness were cost-utility ratio (CUR) using dollars per QALY.Results: Topical cyclosporine, 0.05%, confers a value gain (comparative effectiveness) of 0.0319 QALY per year compared with topical lubricant therapy, a 4.3% improvement in quality of life for the average patient with moderate to severe dry eye syndrome that is unresponsive to conventional lubricant therapy. The societal perspective incremental CUR for cyclosporine over vehicle therapy is $34 953 per QALY and the societal perspective average CUR is $11 199 per QALY. The third-party insurer incremental CUR is $37 179 per QALY, while the third-party-insurer perspective average CUR is $34 343 per QALY.Conclusions: Topical cyclosporine emulsion, 0.05%, confers considerable patient value and is a cost-effective therapy for moderate to severe dry eye syndrome that is unresponsive to conventional therapy.