Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.
BMJ Open. 2017 Jan 13;7(1):e013254. doi: 10.1136/bmjopen-2016-013254.
To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.
Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon.
22 hospital eye services in the UK.
Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).
Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).
Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care.
The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.
We find that lens extraction has a 67-89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years.
ISRCTN44464607; Results.
研究原发性闭角型青光眼（PACG）患者早期晶状体摘除联合人工晶状体植入与标准治疗相比的成本效益。
伴随多中心实用两臂随机对照试验的成本效益分析。患者随访 36 个月，在试验时间范围内收集并分析健康服务使用和健康状态效用数据。开发了一个马尔可夫模型来推断 5 年和 10 年的结果。
英国 22 家医院眼科服务机构。
年龄在 50 岁及以上的新发 PACG 或原发性房角关闭（PAC）的男性和女性。
晶状体摘除与标准治疗（即激光虹膜切开术，随后进行药物治疗和青光眼手术）。
参与者的平均年龄为 67.5（8.42）岁，57.5%为女性，44.6%的双眼符合条件，1.4%为亚洲人种，35.4%为 PAC。随机分配到晶状体摘除组的患者医疗服务费用更高：2467 英镑对 1486 英镑。早期晶状体摘除的调整后 QALY 也更高：2.602 对 2.533。晶状体摘除与标准治疗的 ICER 在 3 年内为每增加一个 QALY 需花费 14284 英镑。模型表明，5 年内 ICER 可能降至 7090 英镑/QALY，10 年内晶状体摘除可能具有成本效益。我们的结果对关键输入参数和假设的变化基本稳健。
我们发现，晶状体摘除在 3 年内有 67-89%的可能性具有成本效益，并且可能在 10 年内具有成本效益。
ISRCTN44464607；结果。
