Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Invest Ophthalmol Vis Sci. 2013 May 13;54(5):3394-9. doi: 10.1167/iovs.12-11549.
To assess the long-term cost-effectiveness of treating normal tension glaucoma (NTG).
A Markov decision-analytic health model was developed to determine the cost-effectiveness of treating NTG with IOP lowering therapy to prevent progressive visual field loss. Transitional probabilities were derived from the Collaborative Normal Tension Glaucoma Study and cost data obtained from the literature and the Medicare fee schedule. Incremental cost-effectiveness ratios (ICER) of treating all patients with NTG and treating selected individuals with risk factors for disease progression were determined using Monte Carlo simulation. Sensitivity analyses were performed by varying the cost of consultations, medications, laser/surgery, and adjusting utility loss from progressed states.
The ICER of treating all patients with NTG over a 10-year period was United States (US) $34,225 per quality-adjusted life year (QALY). The ICER would be reduced when treatment was offered selectively to those with risk factors for disease progression. The ICER for treating NTG patients with disc hemorrhage, migraine, and those who were female were US $24,350, US $25,533, and US $27,000 per QALY, respectively. The cost-effectiveness of treating all NTG patients in this model was sensitive to cost fluctuation of medications, choice of utility score associated with disease progression, and insensitive to cost of consultations and laser/surgery.
It is cost-effective, in the long-term, to offer IOP lowering therapy, aiming for a 30% reduction from the baseline, to all NTG patients. The incremental cost-effectiveness ratio of treating all patients with normal tension glaucoma over a 10-year period was $34,225 per quality-adjusted life year and should be offered to individuals in need.
评估治疗正常眼压性青光眼（NTG）的长期成本效益。
采用马尔可夫决策分析健康模型，确定通过降低眼压治疗 NTG 以预防进行性视野丧失的成本效益。过渡概率来自合作性正常眼压研究，成本数据来自文献和医疗保险费用表。采用蒙特卡罗模拟法确定治疗所有 NTG 患者和治疗具有疾病进展危险因素的特定个体的增量成本效益比（ICER）。通过改变咨询、药物、激光/手术的费用以及调整从进展状态中失去的效用值进行敏感性分析。
在 10 年内治疗所有 NTG 患者的 ICER 为每质量调整生命年（QALY）34225 美元。当仅向具有疾病进展危险因素的患者提供治疗时，ICER 将降低。对盘出血、偏头痛和女性 NTG 患者进行治疗的 ICER 分别为每 QALY 24350 美元、25533 美元和 27000 美元。该模型中治疗所有 NTG 患者的成本效益对药物成本波动、与疾病进展相关的效用评分选择以及对咨询和激光/手术成本不敏感。
长期来看，对所有 NTG 患者提供降低眼压治疗，目标是使基线眼压降低 30%，具有成本效益。在 10 年内治疗所有 NTG 患者的增量成本效益比为每 QALY34225 美元，应提供给有需要的个体。
