Stein Joshua D, Kim David D, Peck Will W, Giannetti Steven M, Hutton David W
Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105, USA.
Arch Ophthalmol. 2012 Apr;130(4):497-505. doi: 10.1001/archophthalmol.2011.2727. Epub 2012 Feb 13.
To determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP).
Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only.
The incremental cost-effectiveness of LTP over no treatment is $16,824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14,179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value.
Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.
确定新诊断为轻度开角型青光眼患者最具成本效益的治疗方案：仅观察、使用普通局部前列腺素类似物（PGA）治疗或激光小梁成形术（LTP）治疗。
我们使用一个为期25年的马尔可夫模型，比较了用PGA、LTP或仅观察来治疗新诊断的轻度开角型青光眼的增量成本效益。
与不治疗相比，LTP的增量成本效益为每质量调整生命年16,824美元。相比之下，PGA与不治疗相比的增量成本效益为每质量调整生命年14,179美元，并且相对于LTP，它们能提供更高的与健康相关的生活质量。如果由于患者依从性差，PGA的效果降低25%，LTP可能具有更大的价值。
前列腺素类似物和LTP都是治疗新诊断的轻度开角型青光眼的具有成本效益的选择。假设药物依从性最佳，与LTP相比，PGA具有更大的价值。然而，当假设药物依从性处于更现实的水平（使其比临床试验中报告的记录有效性低25%）时，以目前PGA的价格，LTP可能是一种更具成本效益的选择。
