Brown G C, Brown M M, Sharma S, Brown H, Tasman W
Retina Vascular Unit, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2000 Jul;107(7):1374-80. doi: 10.1016/s0161-6420(00)00169-x.
To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization.
Computer-based econometric modeling.
The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money.
Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis.
Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration.
Cost per quality-adjusted life-year ($/QALY gained) associated with laser therapy.
Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant $/QALY gained was $5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a $/QALY gained of $4974 with no gained discount rate and $11,633 with a yearly discount rate of 10%.
The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.
对激光治疗黄斑下脉络膜新生血管进行基于患者偏好的增量成本效益分析。
基于计算机的计量经济学建模。
将激光光凝治疗的成本效益与黄斑下脉络膜新生血管的自然病程进行比较。该模型应用了先前临床试验的长期视觉数据、效用分析（反映患者对与健康状态相关的生活质量的认知）、采用马尔可夫模型的决策分析以及考虑货币时间价值的贴现现值分析的经济原则。
分析使用了黄斑光凝研究中研究人员获得的符合黄斑下脉络膜新生血管治疗条件的患者数据。
对年龄相关性黄斑变性患者的黄斑下脉络膜新生血管进行模拟激光治疗。
与激光治疗相关的每质量调整生命年成本（$/获得的QALY）。
与不治疗相比，黄斑下脉络膜新生血管的激光光凝治疗使每位接受治疗的患者平均获得0.257个QALY。使用3%的年贴现率来考虑货币时间价值和通货膨胀，所得的$/获得的QALY为5629美元。成本效益分析中使用的敏感性分析得出，在无贴现率时$/获得的QALY为4974美元，在年贴现率为10%时为11633美元。
激光治疗黄斑下脉络膜新生血管的增量费用似乎具有很高的成本效益。该结果考虑了基于患者偏好的效用数据，与不同医学专科的其他介入治疗相比具有相当的优势。
