Smith Andrew F, Pitt Andrew D, Rodruiguez Alejandra E, Alio Jorge L, Marti Nicolas, Teus Miguel, Guillen Santiago, Bataille Laurent, Barnes J Rod
Health Economics Unit, Alcon Laboratories (U.K.) Ltd., Hemel Hempstead, Herts., UK.
Ophthalmic Epidemiol. 2005 Aug;12(4):233-42. doi: 10.1080/09286580590967781.
Seasonal allergic conjunctivitis (SAC) is a highly prevalent condition that exacts a range of costs from its sufferers. The aim of this study was to examine quality of life (QoL) and economic consequences of SAC amongst private health care patients in Spain.
201 sufferers of SAC and 200 controls were recruited from four private eye clinics and one public hospital in five Spanish cities: Alicante, Madrid, Albacete, Las Palmas de Gran Canarias and Valladolid. Participants were between 10 and 80 years of age and Spanish speaking. All potential participants were asked selected questions and sorted into one of the two groups or excluded. Sufferers were administered a set of four questionnaires by researchers consisting of the EQ-5D Health Questionnaire, the National Eye Institute (US) Visual Functioning Questionnaire 25 (VFQ-25), the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and a Health Economic and Demographic Questionnaire (HEDQ). Control participants self-administered the full EQ-5D and VFQ-25 and abbreviated versions of the RQLQ and HEDQ.
The groups were comparable in terms of age and sex, but sufferers had a significantly higher hourly income than controls (p = 0.02). Sufferers exhibited a significantly higher incidence of asthma, nasal symptoms, perennial allergic conjunctivitis, food allergies and other allergies (p < 0.01 for all comorbidities). Sufferers returned significantly lower quality of life scores than controls in all EQ-5D domains other than mobility (p = 0.14). SAC VFQ-25 scores were significantly less than in controls in the overall vision (p < 0.01), distance vision (p < 0.01), ocular pain (p < 0.01), mental health (p = 0.01), role limitations (p < 0.01), and dependency (p = 0.01) domains. Mean scores for the activity domain of the RQLQ were greater in the sufferer group than the control group (P < 0.01) . The total mean per-sufferer cost of SAC amongst our sample of private patients was 348.50 Euros.
Sufferers experienced QoL reductions in general health and specific aspects of vision as a result of their SAC. In relative terms, the per-capita economic cost of the condition was higher than in a previous public health care study. This was ascribed to sufferers' willingness-to-pay for symptom alleviation. The unexpectedly high expenditure of the proportion of SAC sufferers who receive private health care serves to highlight the importance of SAC as a costly condition. It also illustrates the need to account for both private and public heath care modalities when attempting to ascribe a total cost to a medical condition.
季节性过敏性结膜炎（SAC）是一种非常普遍的疾病，给患者带来了一系列费用支出。本研究旨在调查西班牙私立医疗保健患者中SAC患者的生活质量（QoL）和经济后果。
从西班牙五个城市（阿利坎特、马德里、阿尔瓦塞特、大加那利岛拉斯帕尔马斯和巴利亚多利德）的四家私立眼科诊所和一家公立医院招募了201名SAC患者和200名对照者。参与者年龄在10至80岁之间，讲西班牙语。所有潜在参与者都被问到一些特定问题，并被分为两组之一或被排除。研究人员向患者发放了一组四份问卷，包括EQ-5D健康问卷、美国国立眼科研究所视觉功能问卷25（VFQ-25）、鼻结膜炎生活质量问卷（RQLQ）和一份健康经济与人口统计学问卷（HEDQ）。对照参与者自行填写完整的EQ-5D和VFQ-25以及RQLQ和HEDQ的简化版本。
两组在年龄和性别方面具有可比性，但患者的小时收入显著高于对照者（p = 0.02）。患者的哮喘、鼻部症状、常年性过敏性结膜炎、食物过敏和其他过敏的发病率显著更高（所有合并症的p < 0.01）。除了行动能力领域（p = 0.14）外，患者在所有EQ-5D领域的生活质量得分均显著低于对照者。SAC患者的VFQ-25得分在总体视力（p < 0.01）、远距离视力（p < 0.01）、眼痛（p < 0.01）心理健康（p = 0.01）、角色限制（p < 0.01）和依赖（p = 0.01）领域显著低于对照者。RQLQ活动领域的平均得分在患者组中高于对照组（P < 0.01）。在我们的私立患者样本中，SAC患者的人均总成本为348.50欧元。
由于患有SAC，患者在总体健康和视力特定方面的生活质量有所下降。相对而言，该疾病的人均经济成本高于先前一项公共医疗保健研究中的成本。这归因于患者为缓解症状的支付意愿。接受私立医疗保健的SAC患者比例出现意外高支出，这凸显了SAC作为一种高成本疾病的重要性。这也说明了在试图估算一种医疗状况的总成本时，需要兼顾私立和公共医疗保健模式。
