Rouland Jean-François, Berdeaux Gilles, Lafuma Antoine
Service d'Ophtalmologie, Hôpital Claude Huriez, Lille, France.
Drugs Aging. 2005;22(4):315-21. doi: 10.2165/00002512-200522040-00004.
This paper reviews the burden and economic consequences of glaucoma upon healthcare systems and patients, especially elderly patients. An extensive review of the literature was conducted, primarily using MEDLINE, but also by examining selected article reference lists, relevant websites and the proceedings of specialised conferences. All relevant articles and documents were analysed. Glaucoma is characterised by destruction of the optic nerve. It is most often a continuous, chronic eye disease and the most frequent diagnosis is primary open angle glaucoma (POAG). POAG is mostly associated with intraocular hypertension which can be delayed by medication, surgery or laser therapy. The prevalence rate of glaucoma is about 1% in the population >50 years of age. The rate increases with age and is higher in Black and Hispanic populations. Glaucoma affects more than 67 million people worldwide. Cost-of-illness studies have shown the importance of this disease, on which more than pound300 million was spent in the UK in 2002. Most of the costs (45%) were associated with direct medical costs, but direct nonmedical costs (20%) and indirect costs (35%) were also not negligible. Recent economic studies have shown a dramatic increase in the number of patients with glaucoma receiving treatment but a reduction in use of surgical procedures to treat the condition, especially as first-line therapy. The greater part of medical expenditure is now on medication, with new, more potent, better tolerated, but more costly drugs replacing older and less expensive medications. Treatment costs are directly related to the severity of disease and the number of different treatments used; they are also negatively correlated with treatment efficacy in reducing intraocular pressure. However, long-term economic benefits that may be associated with use of more potent new drugs (by delaying institutionalisation) have never been documented. Glaucoma screening has also been found not to be cost effective, although these results should be reconsidered in the light of new data.
本文综述了青光眼给医疗系统和患者，尤其是老年患者带来的负担及经济后果。我们进行了广泛的文献综述，主要使用MEDLINE数据库，同时也查阅了部分文章的参考文献列表、相关网站以及专业会议的论文集。对所有相关文章和文献进行了分析。青光眼的特征是视神经受损。它通常是一种持续的慢性眼病，最常见的诊断是原发性开角型青光眼（POAG）。POAG大多与眼压升高有关，可通过药物、手术或激光治疗来延缓病情发展。50岁以上人群中青光眼的患病率约为1%。患病率随年龄增长而上升，在黑人和西班牙裔人群中更高。全球有超过6700万人受青光眼影响。疾病成本研究表明了这种疾病的重要性，2002年英国在这方面的花费超过3亿英镑。大部分成本（45%）与直接医疗成本相关，但直接非医疗成本（20%）和间接成本（35%）也不容忽视。近期的经济学研究表明，接受治疗的青光眼患者数量急剧增加，但治疗该病的手术程序使用有所减少，尤其是作为一线治疗手段时。现在大部分医疗支出用于药物治疗，新型、药效更强、耐受性更好但成本更高的药物取代了旧的、价格较低的药物。治疗成本与疾病严重程度和使用的不同治疗方法数量直接相关；它们还与降低眼压的治疗效果呈负相关。然而，使用药效更强的新药可能带来的长期经济效益（如延迟入住养老院）从未得到证实。尽管鉴于新数据这些结果应重新考虑，但青光眼筛查也被发现不具有成本效益。
