患者预期寿命对高眼压症治疗成本效益的影响。
Effect of patient's life expectancy on the cost-effectiveness of treatment for ocular hypertension.
作者信息
Kymes Steven M, Plotzke Michael R, Kass Michael A, Boland Michael V, Gordon Mae O
机构信息
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Campus Box 8096, 660 S Euclid Ave, St Louis, MO 63110-1093, USA.
出版信息
Arch Ophthalmol. 2010 May;128(5):613-8. doi: 10.1001/archophthalmol.2010.83.
OBJECTIVE
To assess the influence of expected life span on the cost-effectiveness of treating ocular hypertension to prevent primary open-angle glaucoma.
METHODS
We used a Markov simulation model to estimate the cost and benefit of ocular hypertension treatment over a person's remaining life. We examined the influence of age on the cost-effectiveness decision in 2 ways: (1) by evaluating specific age cohorts to assess the influence of age at the initiation of treatment; and (2) by evaluating the influence of a specific life span.
RESULTS
At a willingness to pay $50,000/quality-adjusted life year to $100,000/quality-adjusted life year, treatment of people with a 2% or greater annual risk of developing glaucoma was cost-effective for people aged 45 years with a life expectancy of at least 18 remaining years. However, to be cost-effective, a person aged 55 years must have a life expectancy of 21 remaining years and someone aged 65 years must have a life expectancy of 23 remaining years.
CONCLUSIONS
A person with ocular hypertension must have a life expectancy of at least 18 remaining years to justify treatment at a threshold of a 2% or greater annual risk of developing glaucoma. Persons at higher levels of risk require a life expectancy of 7 to 10 additional years to justify treatment.
目的
评估预期寿命对治疗高眼压症以预防原发性开角型青光眼成本效益的影响。
方法
我们使用马尔可夫模拟模型来估计一个人余生中高眼压症治疗的成本和效益。我们通过两种方式研究年龄对成本效益决策的影响：（1）评估特定年龄组以评估治疗开始时年龄的影响；（2）评估特定寿命的影响。
结果
在每质量调整生命年支付意愿为50,000美元至100,000美元的情况下，对于45岁且预期寿命至少还有18年的人，每年患青光眼风险为2%或更高的人群进行治疗具有成本效益。然而，要具有成本效益，55岁的人必须预期寿命还有21年，65岁的人必须预期寿命还有23年。
结论
高眼压症患者必须预期寿命至少还有18年，才能在每年患青光眼风险为2%或更高的阈值下证明治疗的合理性。风险较高的人群需要额外7至10年的预期寿命才能证明治疗的合理性。
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