Lin James, Chang Jonathan S, Smiddy William E
Department of Ophthalmology, Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.
Department of Ophthalmology, Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.
Ophthalmology. 2016 Sep;123(9):1912-8. doi: 10.1016/j.ophtha.2016.05.037. Epub 2016 Jul 15.
To evaluate costs of panretinal photocoagulation (PRP) vs. intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR).
A Markov-style model of cost-effectiveness and cost utility.
There were no participants.
Based on results from Diabetic Retinopathy Clinical Research (DRCR) Network Protocol S, we performed a Markov-style analysis to generate the total 2-year costs for each treatment arm. The cost per line-year saved and cost utility were calculated based on the estimated life years remaining. Both treatment arms were assumed to result in 9 lines of vision saved in 20% of patients. Medicare reimbursement data were acquired to determine costs, which were then separately calculated for practice settings of a hospital-based facility as the highest end of the cost range and a nonfacility in the same geographic area as the lowest end. Cost parameters for a prototypical patient's life expectancy also were modeled and calculated.
Inputed cost of therapy, cost per line saved, cost per line-year saved, and cost per quality-adjusted life years (QALY).
When PRP was the primary treatment, the 2-year cost in the facility setting was $13 053, with cost per line saved $7252, cost per line-year $240, and cost per QALY $7988. In the nonfacility setting costs were approximately 21% lower. When IVR was the primary treatment, the 2-year cost in the facility setting was $30 328, cost per line saved was $16 849, cost per line-year $575, and cost per QALY $19 150. In the nonfacility setting costs were approximately 15% lower. Extrapolation to lifetime therapy yielded the cost per QALY with PRP treatment of $14 219 to $24 005 and with IVR of $138 852 to $164 360. Cost utility for PRP would be 85% lower than IVR in the facility setting and 90% lower than IVR in the nonfacility setting.
PRP compared with IVR as primary treatment for PDR is less expensive over 2 years, but both fall well below the accepted cost per QALY upper limit. However, over an average lifetime, the cost differential between PRP and IVR increases, and IVR therapy may exceed the typical accepted limit of cost per QALY.
评估全视网膜光凝（PRP）与玻璃体内注射雷珠单抗（IVR）治疗增殖性糖尿病视网膜病变（PDR）的成本。
成本效益和成本效用的马尔可夫模型。
无。
基于糖尿病视网膜病变临床研究（DRCR）网络方案S的结果，我们进行了马尔可夫分析，以得出每个治疗组的2年总成本。根据剩余的估计生命年数计算每挽救一行视力的成本和成本效用。假设两个治疗组在20%的患者中可挽救9行视力。获取医疗保险报销数据以确定成本，然后分别针对医院设施环境（作为成本范围的最高端）和同一地理区域的非设施环境（作为成本范围的最低端）计算成本。还对典型患者预期寿命的成本参数进行了建模和计算。
治疗的投入成本、每行挽救成本、每行每年挽救成本以及每质量调整生命年（QALY）成本。
当PRP作为主要治疗方法时，设施环境下的2年成本为13,053美元，每行挽救成本为7252美元，每行每年成本为240美元，每QALY成本为7988美元。在非设施环境下，成本约低21%。当IVR作为主要治疗方法时，设施环境下的2年成本为30,328美元，每行挽救成本为16,849美元，每行每年成本为575美元，每QALY成本为19,150美元。在非设施环境下，成本约低15%。外推至终身治疗得出PRP治疗的每QALY成本为14,219美元至24,005美元，IVR治疗的每QALY成本为138,852美元至164,360美元。在设施环境下，PRP的成本效用比IVR低85%，在非设施环境下比IVR低90%。
与IVR相比，PRP作为PDR的主要治疗方法在2年内成本较低，但两者均远低于公认的每QALY成本上限。然而，在平均一生中，PRP与IVR之间的成本差异会增加，IVR治疗可能会超过每QALY成本的典型公认上限。
