Lee Paul P, Walt John G, Doyle John J, Kotak Sameer V, Evans Stacy J, Budenz Donald L, Chen Philip P, Coleman Anne L, Feldman Robert M, Jampel Henry D, Katz L Jay, Mills Richard P, Myers Jonathan S, Noecker Robert J, Piltz-Seymour Jody R, Ritch Robert R, Schacknow Paul N, Serle Janet B, Trick Gary L
Duke University Medical Center, Durham, NC 27710, USA.
Arch Ophthalmol. 2006 Jan;124(1):12-9. doi: 10.1001/archopht.124.1.12.
To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels.
Observational, retrospective cohort study based on medical record review.
One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age > or =18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment-related resource consumption were excluded.
Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patient-level direct costs from the payer perspective.
Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed.
Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%).
The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.
研究不同疾病严重程度下青光眼治疗的资源消耗和直接成本。
基于病历回顾的观察性、回顾性队列研究。
从美国12个地点随机选取151例原发性开角型或正常眼压性青光眼、青光眼疑似患者或高眼压症患者（年龄≥18岁）的记录，并根据《国际疾病分类，第九版，临床修订本》编码按严重程度分层。患者必须至少随访5年。排除可能影响青光眼治疗相关资源消耗的合并眼部疾病患者。
采用改良自巴斯科姆·帕尔默（霍达普-安德森-帕里什）系统的6阶段青光眼分期系统评估并确定青光眼严重程度。从病历回顾中收集临床和资源使用数据。根据专家调查估算终末期疾病患者的低视力护理和视力康复资源消耗。然后，针对疾病的每个阶段，应用公开可得的经济数据进行资源估值，并从支付方角度估算患者层面的直接成本。
在患者层面计算平均年度资源使用量和估计的年度治疗总直接成本，并按疾病阶段分层。还评估了特定资源类型的直接成本，包括眼科就诊、青光眼手术、药物、视野检查和其他青光眼服务。
与眼科直接相关的资源使用，包括眼科就诊、青光眼手术和药物使用，随着疾病严重程度的加重而增加。治疗的平均直接成本从青光眼疑似患者或早期疾病患者的每年每人623美元到终末期疾病患者的每年每人2511美元不等。药物成本在疾病各阶段的总直接成本中占比最大（范围为24%-61%）。
研究结果表明，青光眼管理的资源使用和直接成本随着疾病严重程度的加重而增加。基于这些发现，一种能延缓疾病进展的青光眼治疗方法可能有潜力在多年内显著降低这种慢性病的健康经济负担。
