Peeters A, Schouten J S A G, Webers C A B, Prins M H, Hendrikse F, Severens J L
Department of Ophthalmology, Maastricht University Hospital, Maastricht, The Netherlands.
Eye (Lond). 2008 Mar;22(3):354-62. doi: 10.1038/sj.eye.6702637. Epub 2006 Nov 24.
To determine the most cost-effective case-finding strategy for the ophthalmologist to detect and treat ocular hypertension (OH) and primary open-angle glaucoma (POAG) at an early stage to prevent blindness.
A Markov cost-effectiveness simulation model.
Three case-finding strategies are analysed and compared. The simulated cohort consists of all initial patients of at least 40 years old visiting an ophthalmic practice. All patients undergo ophthalmoscopy, but tonometry is routinely performed to: (1) all initial patients, (2) high-risk patients only, or (3) no one. The population characteristics are based on data of 1000 initial patients. Transition probabilities are taken from the literature. The (direct) costs of diagnosis and treatment represent those for the Netherlands. The time-horizon of the model is 20 years. An annual discount rate of 4% is used.
Costs, proportion of patients becoming blind, years of blindness.
The costliest strategy (1) leads to least blindness. The incremental cost-effectiveness ratio, which shows extra costs per year of vision saved in comparison to the cheapest strategy (3), is lower for strategy (1) than for strategy (2). It amounts to euro1707, not including extra costs due to blindness (eg associated with the use of disability facilities). When such costs exceed euro1707 per patient per year, which is most likely, then strategy (1) becomes cost saving.
It is most cost-effective to routinely perform tonometry to all initial ophthalmic patients to prevent blindness due to glaucoma.
确定对眼科医生而言最具成本效益的病例发现策略，以便在早期阶段检测和治疗高眼压症（OH）和原发性开角型青光眼（POAG），从而预防失明。
马尔可夫成本效益模拟模型。
分析并比较三种病例发现策略。模拟队列由所有至少40岁初诊眼科诊所的患者组成。所有患者均接受检眼镜检查，但眼压测量仅常规应用于：（1）所有初诊患者；（2）仅高危患者；或（3）不应用于任何人。人群特征基于1000例初诊患者的数据。转移概率取自文献。诊断和治疗的（直接）成本代表荷兰的成本。模型的时间范围为20年。采用4%的年贴现率。
成本、失明患者比例、失明年数。
成本最高的策略（1）导致的失明最少。与最便宜的策略（3）相比，增量成本效益比显示了每年节省视力的额外成本，策略（1）的该比值低于策略（2）。其金额为1707欧元，不包括失明导致的额外成本（如与使用残疾设施相关的成本）。如果此类成本超过每位患者每年1707欧元，这很可能发生，那么策略（1）就会节省成本。
对所有初诊眼科患者常规进行眼压测量以预防青光眼导致的失明是最具成本效益的。
