Ma Yingyan, Ying Xiaohua, Zou Haidong, Xu Xiaocheng, Liu Haiyun, Bai Lin, Xu Xun, Zhang Xi
Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
School of Public Health, Fudan University, Shanghai, China.
PLoS One. 2014 Oct 17;9(10):e110256. doi: 10.1371/journal.pone.0110256. eCollection 2014.
To evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness.
Elderly patients over 70 years old, who were diagnosed and underwent RRD surgery at Shanghai First People's Hospital, Shanghai Jiao Tong University, China, from January 1, 2009, through January 1, 2013. The participants received scleral buckling surgery and vitreous surgery with or without scleral buckling under retrobulbar anesthesia. We followed the patients for 1 year and collected best-corrected visual acuity (BCVA), vision-related quality of life, and direct medical costs data. Utility values elicited by time-trade-off were analyzed to determine the quality of life. Quality-adjusted life years (QALYs) gained in life expectancy were calculated and discounted at 3% annually. Costs per QALY gained were reported using the bootstrap method. Further analyses were made for two age groups, age 70-79 and age over 80 years. Sensitivity analyses were performed to test stability of the results.
98 patients were included in the study. The BCVA significantly improved by 0.53±0.44 (Logarithm of the Minimum Angle of Resolution (logMAR)) at the 1-year postoperative time point (p<0.001). Utility values increased from 0.77 to 0.84 (p<0.001), and an average of 0.4 QALYs were gained in the life expectancy. Costs per QALY gained from the RRD surgery were 33,186 Chinese Yuan (CNY) (5,276 US dollars (USD))/QALY; 24,535 CNY (3,901 USD)/QALY for the age group of 70-79 years and 71,240 CNY (11,326 USD)/QALY for the age group over 80 years.
RRD surgery improved the visual acuity and quality of life in the elderly patients over 70 years old. According to the World Health Organization's recommendation, at a threshold of willingness to pay of 115,062 CNY (18,293 USD)/QALY, RRD surgery is cost effective in the elderly patients.
从视力、视力相关生活质量及其成本效益方面评估孔源性视网膜脱离（RRD）手术对老年患者的影响。
选取2009年1月1日至2013年1月1日期间在上海交通大学附属第一人民医院诊断并接受RRD手术的70岁以上老年患者。参与者在球后麻醉下接受巩膜扣带术以及联合或不联合巩膜扣带术的玻璃体手术。我们对患者进行了1年的随访，并收集了最佳矫正视力（BCVA）、视力相关生活质量以及直接医疗费用数据。分析通过时间权衡法得出的效用值以确定生活质量。计算预期寿命中获得的质量调整生命年（QALY），并按每年3%进行贴现。使用自抽样法报告每获得一个QALY的成本。对70 - 79岁和80岁以上两个年龄组进行了进一步分析。进行敏感性分析以检验结果的稳定性。
98例患者纳入研究。术后1年时，BCVA显著提高了0.53±0.44（最小分辨角对数（logMAR））（p<0.001）。效用值从0.77增至0.84（p<0.001），预期寿命中平均获得0.4个QALY。RRD手术每获得一个QALY的成本为33,186元人民币（CNY）（5,276美元（USD））/QALY；70 - 79岁年龄组为24,535元人民币（3,901美元）/QALY，80岁以上年龄组为71,240元人民币（11,326美元）/QALY。
RRD手术改善了70岁以上老年患者的视力和生活质量。根据世界卫生组织的建议，在支付意愿阈值为115,062元人民币（18,293美元）/QALY时，RRD手术对老年患者具有成本效益。
