在安大略省医疗保险计划中，与青光眼药物相比，Trabectome、iStent 和经内镜睫状体光凝术的预期成本比较。
Projected cost comparison of Trabectome, iStent, and endoscopic cyclophotocoagulation versus glaucoma medication in the Ontario Health Insurance Plan.
机构信息
Departments of *Ophthalmology †Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
出版信息
J Glaucoma. 2014 Feb;23(2):e112-8. doi: 10.1097/IJG.0b013e31829d9bc7.
PURPOSE
To compare the direct cost of treating glaucoma patients with Trabectome, iStent, and endoscopic cyclophotocoagulation (ECP) versus topical medications in Ontario, Canada. Costs are projected over a 6-year period, and presented on a per-patient level from the perspective of the Ontario Health Insurance Plan (OHIP).
METHODS
The per-bottle cost of each medication was obtained from the 2011 Ontario Drug Benefit (ODB) formulary. A wastage adjustment fee was added to the cost, as was a pharmacy markup, and an ODB dispensing fee. Previously published medication prescription rates were used to determine the frequency with which each medication is prescribed. We estimated the overall cost by taking a weighted average of the cost of each class of glaucoma medications.The cost of each glaucoma device was determined by contacting local distributors. We then added the cost of disposables used during surgery (viscoelastic and keratome) to the cost of each procedure. Start-up costs for each device and surgeons' fees were excluded from the overall cost.
RESULTS
At 6 years, treatment with the Trabectome offered a cumulative cost savings of $279.23, $1572.55, and $2424.71 per patient versus monodrug, bidrug, and tridrug therapy, respectively. A cumulative cost difference of -$20.77, $1272.55, and $2124.71 per patient were found when comparing iStent versus monodrug, bidrug, and tridrug therapy, respectively. Treatment with ECP yielded a cost savings of $779.23, $2072.55, and $2924.71 per patient versus monodrug, bidrug, and tridrug therapy, respectively.
CONCLUSIONS
Over a projected period of 6 years, the Trabectome, iStent, and ECP may all offer a modest cost savings to OHIP versus the cost of glaucoma medication. Further analysis of direct and indirect costs to patients as well as quality of life assessments will help further delineate the role of these treatments in the glaucoma treatment paradigm.
目的
比较在加拿大安大略省，使用 Trabectome、iStent 和经巩膜睫状体光凝术（ECP）治疗青光眼患者的直接成本与局部药物治疗相比。成本预测在 6 年内进行，并从安大略省医疗保险计划（OHIP）的角度按每位患者的水平呈现。
方法
从 2011 年安大略省药物福利（ODB）处方集获得每种药物的每瓶成本。在成本中增加了损耗调整费、药房加价和 ODB 配药费。使用先前发表的药物处方率来确定每种药物的处方频率。通过对每类青光眼药物的成本进行加权平均，我们估计了总体成本。每种青光眼设备的成本是通过联系当地经销商确定的。然后，我们将手术过程中使用的一次性用品（粘性和角膜刀）的成本添加到每个程序的成本中。每个设备的启动成本和外科医生的费用不包括在总成本中。
结果
在 6 年内，与单药治疗、双联药物治疗和三联药物治疗相比，Trabectome 治疗的累积成本节省分别为每位患者 279.23 美元、1572.55 美元和 2424.71 美元。与单药治疗、双联药物治疗和三联药物治疗相比，iStent 的累积成本差异分别为每位患者-20.77 美元、1272.55 美元和 2124.71 美元。与单药治疗、双联药物治疗和三联药物治疗相比，ECP 治疗的成本节省分别为每位患者 779.23 美元、2072.55 美元和 2924.71 美元。
结论
在预计的 6 年内，与青光眼药物治疗相比，Trabectome、iStent 和 ECP 可能都会为 OHIP 节省少量成本。进一步分析患者的直接和间接成本以及生活质量评估将有助于进一步确定这些治疗方法在青光眼治疗模式中的作用。
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