Kymes Steven M, Kass Michael A, Anderson Douglas R, Miller J Philip, Gordon Mae O
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
Am J Ophthalmol. 2006 Jun;141(6):997-1008. doi: 10.1016/j.ajo.2006.01.019.
The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of > or =24 mm Hg reduces 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.
Cost-utility analysis with the use of a Markov model.
We modeled a hypothetic cohort of people with IOP of > or =24 mm Hg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a > or =5% annual risk of the development of POAG; (3) treat people with a > or =2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated.
The incremental cost-effectiveness ratios for treatment of people with ocular hypertension were 3670 US dollars per quality adjusted life-year (QALY) for the Treat > or =5% threshold and 42,430 US dollars/QALY for the Treat > or =2% threshold. "Treat everyone" cost more and was less effective than other options. Assuming a cost-effectiveness threshold of 50,000 to 100,000 US dollars/QALY, the Treat > or =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.
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 > or =24 mm Hg and a > or =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.
高眼压治疗研究（OHTS）表明，对眼压（IOP）≥24mmHg的人群进行药物治疗可使原发性开角型青光眼（POAG）的发病风险降低60%。对于哪些高眼压患者会从治疗中获益，目前尚无共识。
使用马尔可夫模型进行成本效用分析。
我们对假设的IOP≥24mmHg的人群队列进行建模。考虑了四个治疗阈值：（1）不治疗任何人；（2）治疗每年发生POAG风险≥5%的人群；（3）治疗每年发生POAG风险≥2%的人群；（4）治疗所有人。评估了增量成本效益比。
对于高眼压患者的治疗，治疗阈值≥5%时的增量成本效益比为每质量调整生命年（QALY）3670美元，治疗阈值≥2%时为42430美元/QALY。“治疗所有人”成本更高且比其他选择效果更差。假设成本效益阈值为50000至100000美元/QALY，治疗阈值≥2%将带来最大的净健康效益。该决策对未经治疗的POAG发病率、治疗效果以及因POAG导致的效用损失敏感。
虽然个体患者的治疗很大程度上取决于他们对疾病进展和失明风险的态度，但对于IOP≥24mmHg且每年发生青光眼风险≥2%的患者进行治疗可能具有成本效益。将所有高眼压患者的治疗推迟到出现青光眼相关症状似乎过于保守。
