Davis Scott A, Himmler Sebastian, Feldman Steven R
Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Dermatol Online J. 2017 May 15;23(5):13030/qt0p516268.
To assess the cost-effectiveness from the payer perspective of using dermatologists versus pediatricians to treat acne in adolescents ages 10-18.
A Markov model was constructed to explore outcomes over a 2-year period from the US private payer perspective. Patients ages 10-18 with acne entered the model under the "dermatologist"and "pediatrician" conditions. In each 3-month cycle,each modeled patient received topical retinoids,benzoyl peroxide (BP), antibiotics, or no treatment,and could progress to an acne-free state or remain in an acne state.
The average patient spent42.3% of the time in acne-free states under the dermatologist condition and 28.0% of the time in acne-free states under the pediatrician condition.The cohort of 1000 patients experienced 1900 total quality-adjusted life years (QALYs) at a cost of $2.33 million in the dermatologist condition and 1883 total QALYs at a cost of $1.62 million in the pediatrician condition, yielding an ICER of $40,000/QALY. Most sensitivity analyses confirmed the base case results.
Dermatologist treatment appears cost-effective related to producing additional QALYs at a cost of less than $100,000 per QALY gained. Health plans should consider creating incentives to direct enrollees to dermatologists for acne treatment.
从支付方的角度评估由皮肤科医生而非儿科医生治疗10 - 18岁青少年痤疮的成本效益。
构建一个马尔可夫模型，从美国私人支付方的角度探究两年期间的治疗结果。10 - 18岁的痤疮患者在“皮肤科医生”和“儿科医生”两种情况下进入模型。在每3个月的周期中，每个模拟患者接受外用维甲酸、过氧化苯甲酰（BP）、抗生素治疗或不接受治疗，并可能进展到无痤疮状态或保持痤疮状态。
在皮肤科医生治疗情况下，平均患者处于无痤疮状态的时间占42.3%，在儿科医生治疗情况下，这一比例为28.0%。1000名患者的队列在皮肤科医生治疗情况下共获得1900个质量调整生命年（QALY），成本为233万美元，在儿科医生治疗情况下共获得1883个QALY，成本为162万美元，增量成本效果比为40,000美元/QALY。大多数敏感性分析证实了基础案例结果。
皮肤科医生的治疗方案似乎具有成本效益，因为每获得一个QALY的成本低于10万美元就能产生额外的QALY。健康计划应考虑制定激励措施，引导参保人找皮肤科医生治疗痤疮。
