加纳原发性开角型青光眼（POAG）的医疗管理成本及处方模式——一项来自三家转诊机构的回顾性横断面研究
Cost of the medical management and prescription pattern for primary open angle glaucoma (POAG) in Ghana-a retrospective cross-sectional study from three referral facilities.
作者信息
Ocansey Stephen, Kyei Samuel, Diafo Ama, Darfor Kwabena Nkansah, Boadi-Kusi Samuel Bert, Aglobitse Peter B
机构信息
Department of Vision and Hearing Sciences, Faculty of Science and Technology, Anglia Ruskin University, Cambridge, UK.
Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
出版信息
BMC Health Serv Res. 2016 Jul 19;16:282. doi: 10.1186/s12913-016-1528-x.
BACKGROUND
Glaucoma is the leading cause of irreversible blindness globally, and treatment involves considerable cost to stakeholders in healthcare. However, there is infrequent availability of cost information and patterns of management, especially in developing countries. This study determined the cost of the medical management of POAG, adherence, and pattern of medication prescription in Ghana.
METHODS
A retrospective cross-sectional study involving 891 Primary Open Angle Glaucoma (POAG) cases seen in the year 2012 at three referral facilities. Demographics, ocular history, resource consumption, medication, test, surgery and other related cost were extracted from 84 patients who had fully complied with their treatment to calculate total cost (TC) based on 2012 estimates. Glaucoma drugs prescribed to patients who had adhered to all their review visits within the period evident from case folders were recorded and analysed for the prescription pattern.
RESULTS
Out of 891 POAG cases seen in 2012, 351(39.4 %) attended all the required review visits, but only 84 (9.4) had fully and continually adhered to all their treatment regimes. They comprised 41(48.8 %) males and 43(51.2 %) females with a mean age of 65 ± 14.8. Majority of the respondents were elderly above 60 year of age (65.5 %). The total estimated cost for the 84 cases in the year was GH¢ 81,237 ($40,619), comprising GH¢ 72,193 ($36,097) direct medication cost and GH¢9,045 ($4,523) direct non-medication cost (surgery and test cost), and an average of GH¢ 967 ($484) for a mean visit of 5.6 ± 1.1 in the year. A total of 673 glaucoma medications had been prescribed for 351 patients for the year, with timolol being the most prescribed (64.19 %) and monotherapy as the most adopted form of therapy (61.06 %). Age and income showed concurrent increase with cost (P ≤ 0.05).
CONCLUSIONS
Cost of managing glaucoma constitutes a substantial financial burden and influenced the pattern of medication prescription.
背景
青光眼是全球不可逆性失明的主要原因，其治疗给医疗保健利益相关者带来了相当大的成本。然而，成本信息及管理模式的获取并不常见，尤其是在发展中国家。本研究确定了加纳原发性开角型青光眼（POAG）的药物治疗成本、依从性及药物处方模式。
方法
一项回顾性横断面研究，纳入了2012年在三家转诊机构就诊的891例原发性开角型青光眼（POAG）病例。从84例完全遵医嘱治疗的患者中提取人口统计学信息、眼部病史、资源消耗、药物、检查、手术及其他相关成本，根据2012年的估算计算总成本（TC）。记录并分析病历中显示在该时间段内所有复诊均按时就诊的患者所开具的青光眼药物，以了解处方模式。
结果
在2012年就诊的891例POAG病例中，351例（39.4%）完成了所有必要的复诊，但只有84例（9.4%）完全且持续地遵守了所有治疗方案。其中男性41例（48.8%），女性43例（51.2%），平均年龄为65±14.8岁。大多数受访者为60岁以上的老年人（65.5%）。这84例患者当年的总估算成本为81,237加纳塞地（40,619美元），其中直接药物成本为72,193加纳塞地（36,097美元），直接非药物成本（手术和检查成本）为9,045加纳塞地（4,523美元），当年平均每次就诊费用为967加纳塞地（484美元），平均就诊次数为5.6±1.1次。当年共为351例患者开具了673种青光眼药物，噻吗洛尔的处方量最大（64.19%），单一疗法是最常用的治疗方式（61.06%）。年龄和收入与成本呈同步增长（P≤0.05）。
结论
青光眼的治疗成本构成了沉重的经济负担，并影响了药物处方模式。
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