Chan Poemen P, Li Emmy Y, Tsoi Kelvin K F, Kwong Yolanda Y, Tham Clement C
*Department of Ophthalmology & Visual Sciences ‡School of Public Health and Primary Care, Faculty of Medicine §Big Data Decision Analytic Research Centre, Chinese University of Hong Kong †Hong Kong Eye Hospital ∥Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
J Glaucoma. 2017 Oct;26(10):911-922. doi: 10.1097/IJG.0000000000000772.
The purpose of this study is to compare the cost effectiveness of phacoemulsification and combined phacotrabeculectomy for lowering intraocular pressure (IOP) in primary angle closure glaucoma (PACG) eyes with coexisting cataract.
Real-life data of 2 previous randomized control trials that involved 51 medically uncontrolled PACG eyes and 72 medically controlled PACG eyes were utilized to calculate the direct cost of treatment. They were followed-up for 2 years. Cost of preoperative assessments, surgical interventions, additional procedures for managing complications and maintenance of filtration, postoperative follow-up, and cost of medications were considered. Cost data of 3 different regions (The United States, People's Republic of China, and Hong Kong) were used for comparison.
The corresponding average costs for treating 1 eye with newly diagnosed PACG by phacoemulsification alone and combined phacotrabeculectomy were US$3479 and US$2439 in the United States, US$1051 and US$861 in China, and US$6856 and US$12087 in Hong Kong. Surgical and medications costs were the 2 key contributors. Combined phacotrabeculectomy was more cost-effective for IOP reduction when calculating with the United States and China cost data, but was less cost-effective when calculating with the Hong Kong cost data. The cost-effectiveness was insensitive to the costs of follow-up visit and investigations, the cost of surgical operations, and the cost of postoperative procedures, but sensitive to the cost fluctuation of medications. Furthermore, for the medically uncontrolled PACG group, phacoemulsification alone became more cost-effective when the cost of medication was reduced by >75%.
Combined phacotrabeculectomy is a more cost-effective option for lowering IOP in PACG eyes with coexisting cataract, over a 2-year follow-up period.
本研究旨在比较超声乳化术与超声乳化小梁切除术联合治疗对原发性闭角型青光眼（PACG）合并白内障患者降低眼压（IOP）的成本效益。
利用2项既往随机对照试验的实际数据，这些试验涉及51例药物治疗无法控制的PACG患者和72例药物治疗可控制的PACG患者，计算治疗的直接成本。对他们进行了2年的随访。考虑了术前评估、手术干预、处理并发症和维持滤过的额外程序、术后随访以及药物成本。使用3个不同地区（美国、中华人民共和国和香港）的成本数据进行比较。
在美国，单纯超声乳化术和超声乳化小梁切除术联合治疗1例新诊断的PACG患者的相应平均成本分别为3479美元和2439美元；在中国分别为1051美元和861美元；在香港分别为6856美元和12087美元。手术和药物成本是两个主要因素。用美国和中国的成本数据计算时，超声乳化小梁切除术联合治疗在降低眼压方面更具成本效益，但用香港的成本数据计算时则成本效益较低。成本效益对随访和检查成本、手术操作成本以及术后程序成本不敏感，但对药物成本波动敏感。此外，对于药物治疗无法控制的PACG组，当药物成本降低>75%时，单纯超声乳化术变得更具成本效益。
在2年的随访期内，超声乳化小梁切除术联合治疗是降低PACG合并白内障患者眼压的更具成本效益的选择。
