Wittenborn John S, Rein David B
Public Health Economics Program, RTI International, Research Triangle Park, North Carolina 27709, USA.
Optom Vis Sci. 2011 Jan;88(1):155-63. doi: 10.1097/OPX.0b013e3181fc30f3.
More than 90% of blindness worldwide exists in the developing world, but information on the social and economic burden and the cost-effectiveness of treatment in these settings is often limited or nonexistent. We demonstrate the use of computer modeling to simulate the current and future epidemiology, outcomes, and treatment of primary open-angle glaucoma in high-incidence populations of the developing world.
A previously validated vision model was modified to simulate the incidence progression and social and economic outcomes of glaucoma in Barbados, which was the source of epidemiology data, and Ghana, which has similar propensity for glaucoma but lower socioeconomic development. We then assessed the cost-effectiveness of hypothetical case-finding and treatment scenarios, including U.S. guideline-level care and one-time laser surgery.
Barbados incurs relatively greater social and economic burden from glaucoma than Ghana. In Barbados, population screening followed by U.S. guideline levels of care appears to be highly cost-effective. Because of a younger population with higher mortality at younger ages, glaucoma appears to cause less visual impairment and blindness in Ghana than in Barbados, resulting in lower per capita disability and productivity losses. Population screening or guideline-level treatment scenarios were generally not cost-effective in Ghana, but treating self-referring patients with a hypothetical one-time laser surgery was highly cost-effective relative to World Health Organization willingness to pay thresholds.
The social and economic burden of glaucoma is higher in developed nations because of increased life expectancy, an older population age profile, and higher per capita gross domestic product. Similarly, lower mortality rates and higher per capita gross domestic product increase the relative cost-effectiveness of screening and treatment interventions intended to mitigate glaucoma burden.
全球超过90%的失明病例存在于发展中世界，但关于这些地区青光眼的社会经济负担以及治疗成本效益的信息往往有限或根本不存在。我们展示了如何使用计算机建模来模拟发展中世界高发病率人群原发性开角型青光眼的当前及未来流行病学、治疗结果和治疗情况。
对一个先前经过验证的视力模型进行修改，以模拟巴巴多斯（流行病学数据来源地）和加纳（青光眼发病倾向相似但社会经济发展水平较低）青光眼的发病率进展、社会经济结果。然后，我们评估了假设的病例发现和治疗方案的成本效益，包括美国指南级别的治疗和一次性激光手术。
巴巴多斯因青光眼承受的社会和经济负担比加纳更大。在巴巴多斯，采用美国指南级别的护理进行人群筛查似乎具有很高的成本效益。由于加纳人口更年轻且年轻时死亡率更高，青光眼在加纳导致的视力损害和失明似乎比在巴巴多斯少，人均残疾和生产力损失也更低。在加纳，人群筛查或指南级治疗方案通常不具有成本效益，但相对于世界卫生组织的支付意愿阈值而言，用假设的一次性激光手术治疗自行前来就诊的患者具有很高的成本效益。
由于预期寿命增加、人口年龄结构老化以及人均国内生产总值较高，发达国家青光眼的社会和经济负担更高。同样，较低的死亡率和较高的人均国内生产总值提高了旨在减轻青光眼负担的筛查和治疗干预措施的相对成本效益。
