Shepard Donald S, Razavi Moaven, Stason William B, Jacobs Deborah S, Suaya Jose A, Cohen Mark, Rosenthal Perry
Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts 02454, USA.
Am J Ophthalmol. 2009 Dec;148(6):860-8.e2. doi: 10.1016/j.ajo.2009.07.012. Epub 2009 Sep 24.
To perform an economic appraisal of the Boston Ocular Surface Prosthesis in patients with corneal ectasia, irregular astigmatism, or ocular surface disease.
Cost, incremental cost-effectiveness, and benefit-cost analyses in a prospective observational study.
The effects of this scleral lens on visual functioning were measured in 69 patients who received the prosthesis in 2006 and were reassessed 6 months after fitting the prosthesis. Benefits, based on improvements in visual functioning, were converted to quality-adjusted life years (QALYs), and economic values were derived using results from published studies. Costs were estimated from the provider organization's 2006 operating financial statement with additions for donated resources and future scale-up.
Mean scores on a 100-point visual functioning questionnaire (VFQ-25) improved from 57.0 to 77.8 (P < .0001). On average, each fitted patient cost $11,841 ($6001 for clinical services and $5840 to produce the prosthesis). Patients' quality of life improved by 0.10 QALYs per year. Assuming that benefits persist for an average of 5 years, the lifetime gain was 0.48 QALYs; the average cost-effectiveness of the prosthesis was $24,900 per QALY (95% confidence interval $19,100 to $29,600), and the average benefit-cost ratio was 4.0 to 1. In patients with the lowest baseline scores (average VFQ score 38.6), results were even more favorable: cost-effectiveness $17,100 per QALY and benefit-cost ratio 5.6 to 1.
The Boston Ocular Surface Prosthesis is cost-effective and cost beneficial in patients with severely compromised visual function attributable to ectasia, irregular astigmatism, or ocular surface disease.
对波士顿眼表假体用于圆锥角膜、不规则散光或眼表疾病患者进行经济学评估。
前瞻性观察性研究中的成本、增量成本效益及效益成本分析。
对2006年接受该假体的69例患者测量这种巩膜镜对视觉功能的影响，并在佩戴假体6个月后重新评估。基于视觉功能改善的效益转化为质量调整生命年（QALYs），并使用已发表研究的结果得出经济价值。成本根据提供者组织2006年的运营财务报表估算，并加上捐赠资源和未来扩大规模的费用。
100分制视觉功能问卷（VFQ - 25）的平均得分从57.0提高到77.8（P <.0001）。平均而言，每位佩戴患者的成本为11,841美元（临床服务6001美元，生产假体5840美元）。患者的生活质量每年提高0.10个QALYs。假设效益平均持续5年，终身收益为0.48个QALYs；假体的平均成本效益为每QALY 24,900美元（95%置信区间19,100美元至29,600美元），平均效益成本比为4.0比1。在基线得分最低的患者（平均VFQ得分38.6）中，结果更有利：成本效益为每QALY 17,100美元，效益成本比为5.6比1。
波士顿眼表假体对于因圆锥角膜、不规则散光或眼表疾病导致视觉功能严重受损的患者具有成本效益且成本有益。
