Management of ocular hypertension: A cost-effectiveness approach from the ocular hypertension treatment study
Management of ocular hypertension: A cost-effectiveness approach from the ocular hypertension treatment study
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DOI：
10.1016/j.ajo.2006.01.019
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发表时间：
2006-06-01
影响因子：
4.2
通讯作者：
Gordon, Mae O.
中科院分区：
文献类型：
--
作者：
Kymes, Steven M.;Kass, Michael A.;Gordon, Mae O.
目得：高眼压治疗研究（OHTS）表明，对眼内压（IOP）>= 24 mm Hg的人进行药物治疗可将患原发性开角型青光眼（POAG）的风险降低60%。对于哪些高眼压患者会从治疗中受益尚无共识。设计：使用马尔科夫模型进行成本效用分析。方法：我们对假设的IOP>= 24 mm Hg的人群进行建模。考虑了四个治疗阈值：（1）不治疗任何人;（2）治疗POAG年风险≥ 5%的人;（3）治疗POAG年风险≥ 2%的人;（4）治疗所有人。结果：治疗高眼压患者的增量成本-效果比为：治疗>= 5%阈值的每质量调整生命年（QALY）3670美元，治疗>= 2%阈值的每QALY 42,430美元。“治疗每个人”比其他选择成本更高，效果更差。假设成本效益阈值为50，000至100，000美元/QALY，治疗>= 2%阈值将产生最大的净健康效益。这一决定是敏感的发病率POAG未经治疗，治疗的有效性和效用损失，因为POAG。结论：虽然个体患者的治疗在很大程度上取决于他们对疾病进展和失明风险的态度，但对IOP>= 24 mm Hg且每年发生青光眼风险>= 2%的患者的治疗可能具有成本效益。对所有高眼压患者延迟治疗直到出现青光眼相关症状似乎是不必要的保守。
PURPOSE: The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of >= 24 mm Hg re duces the risk of the development of primary open-angle glaucoma (POAG) by 60%. There is no consensus on which people with ocular hypertension would benefit from treatment.DESIGN: Cost-utility analysis with the use of a Markov model.METHODS: We modeled a hypothetic cohort of people with IOP of >= 24 mm Hg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a >= 5% annual risk of the development of POAG; (3) treat people with a >= 2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated.RESULTS: The incremental cost,effectiveness ratios for treatment of people with ocular hypertension were $3670 per quality adjusted life,year (QALY) for the Treat >= 5% threshold and $42,430/QALY for the Treat >= 2% threshold. "Treat everyone" cost more and was less effective than other options. Assuming a cost-effectiveness threshold of $50,000 to 100,000/QALY, the Treat >= 2% threshold would result in the most net health benefit. The decision was sensitive to the incidence of POAG without treatment, treatment effectiveness, and the utility loss because of POAG. CONCLUSION: Although the treatment of individual patients is largely dependent on their attitude toward the risk of disease progression and blindness, the treatment of those patients with IOP of >= 24 mm Hg and a >= 2% annual risk of the development of glaucoma is likely to be cost-effective. Delay of treatment for all people with ocular hypertension until glaucoma-related symptoms are present appears to be unnecessarily conservative.