Stewart William C, Stewart Jeanette A, Nasser Qasiem J, Mychaskiw Marko A
PRN Pharmaceutical Research Network, LLC, Charleston, South Carolina, USA.
Ophthalmology. 2008 Jan;115(1):94-8. doi: 10.1016/j.ophtha.2007.01.040.
To assess the cost-effectiveness of treating ocular hypertension (OHT) in the United States.
A Markov model was constructed to perform a cost-effectiveness analysis.
Patients with OHT.
The health states considered were stable OHT and glaucoma. Practice patterns for the model were derived from the Ocular Hypertension Treatment Study (OHTS), and transition probabilities were derived from previous literature. Specific unit costs used for medications, patient visits, and diagnostic and therapeutic procedures were obtained from Blue Cross/Blue Shield. The time horizon was 5 years. Costs were discounted at 3% per annum.
Long-term cost effectiveness of treating OHT to prevent the development of glaucoma.
The incremental cost-effectiveness ratio (ICER) for all OHT patients to prevent 1 case from progressing to primary open-angle glaucoma was $89,072. However, the minimally cost-effective ICER level after adjustment for risk factors identified by multivariate analysis in the OHTS were: 20 years above the average of 56 years, ICER of $45,155; 4 mmHg above the average pressure of 25 mmHg, ICER of $46,748; 40 microm less than the average central corneal thickness of 573 mum, ICER of $36,683; and a vertical cup-to-disc ratio of 0.2 wider than the average of 0.4, ICER of $35,633.
Based on the results and practice patterns of the OHTS, treating all OHT patients seems not to be cost-effective. However, treating selective OHT patients with risk factors identified in the OHTS, for example, advancing age, higher pressures, thinner central corneal thickness, and wider vertical cup-to-disc ratios, does seem to be cost-effective for preventing the onset of glaucomatous damage.
评估在美国治疗高眼压症（OHT）的成本效益。
构建马尔可夫模型以进行成本效益分析。
高眼压症患者。
所考虑的健康状态为稳定的高眼压症和青光眼。模型的实践模式源自高眼压症治疗研究（OHTS），转移概率源自先前的文献。用于药物、患者就诊以及诊断和治疗程序的特定单位成本取自蓝十字/蓝盾公司。时间范围为5年。成本按每年3%进行贴现。
治疗高眼压症以预防青光眼发展的长期成本效益。
所有高眼压症患者预防1例进展为原发性开角型青光眼的增量成本效益比（ICER）为89,072美元。然而，根据OHTS中多变量分析确定的风险因素进行调整后，最低成本效益的ICER水平为：年龄比平均56岁大20岁，ICER为45,155美元；眼压比平均25 mmHg高4 mmHg，ICER为46,748美元；中央角膜厚度比平均573μm少40μm，ICER为36,683美元；垂直杯盘比比平均0.4宽0.2，ICER为35,633美元。
基于OHTS的结果和实践模式，治疗所有高眼压症患者似乎不具有成本效益。然而，治疗具有OHTS中确定的风险因素的选择性高眼压症患者，例如年龄增长、眼压升高、中央角膜厚度变薄和垂直杯盘比变宽，对于预防青光眼性损害的发生似乎具有成本效益。
