Windsor Matthew A, Sun Sissi J J, Frick Kevin D, Swanson Eric A, Rosenfeld Philip J, Huang David
Association for Research in Vision and Ophthalmology, Rockville, Maryland.
Johns Hopkins Carey Business School, Baltimore, Maryland.
Am J Ophthalmol. 2018 Jan;185:115-122. doi: 10.1016/j.ajo.2017.09.027. Epub 2017 Dec 7.
To compare patient and Medicare savings from the use of optical coherence tomography (OCT) in guiding therapy for neovascular age-related macular degeneration (nvAMD) to the research investments made in developing OCT by the National Institutes of Health (NIH) and the National Science Foundation (NSF).
Observational cohort study.
Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology codes on intravitreal injections (67028), retinal OCT imaging (92134), and anti-vascular endothelial growth factor (anti-VEGF) treatment-specific J-codes (J0178, J2778, J9035, J3490, and J3590). These claims were identified from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services among fee-for-service (FFS) Medicare beneficiaries from 2012 to 2015; 2008 claims were acquired from the 100% FFS Part B Medicare Claims File. OCT research costs were determined by searching for grants awarded by NIH and NSF from inception to 2015. All costs and savings were discounted by 3% annually and adjusted for inflation to 2015 dollars.
From 2008 to 2015, the United States government and nvAMD patients have accrued an estimated savings of $9.0 billion and $2.2 billion, respectively, from the use of OCT to guide personalized anti-VEGF treatment. The $9.0 billion represents a 21-fold return on government investment into developing the technology through NIH and NSF grants.
Although an overall cost-benefit ratio of government-sponsored research is difficult to estimate because the benefit may be diffuse and delayed, the investment in OCT over 2 decades has been recouped many times over in just a few years through better personalized therapy.
比较在指导新生血管性年龄相关性黄斑变性（nvAMD）治疗中使用光学相干断层扫描（OCT）所节省的患者费用和医疗保险费用，与美国国立卫生研究院（NIH）和美国国家科学基金会（NSF）在开发OCT方面的研究投资。
观察性队列研究。
主要结局指标是医疗保险支出，通过现行程序术语编码追踪玻璃体内注射（67028）、视网膜OCT成像（92134）以及抗血管内皮生长因子（抗VEGF）治疗特定的J编码（J0178、J2778、J9035、J3490和J3590）。这些索赔数据来自医疗保险和医疗补助服务中心的医疗保险提供者利用和支付数据，涉及2012年至2015年按服务收费（FFS）的医疗保险受益人；2008年的索赔数据来自100% FFS B部分医疗保险索赔文件。OCT研究成本通过搜索NIH和NSF从成立到2015年授予的拨款来确定。所有成本和节省的费用均按每年3%进行贴现，并根据通货膨胀调整为2015年的美元价值。
从2008年到2015年，美国政府和nvAMD患者通过使用OCT指导个性化抗VEGF治疗分别节省了约90亿美元和22亿美元。这90亿美元代表了政府通过NIH和NSF拨款对该技术开发投资的21倍回报。
尽管政府资助研究的总体成本效益比难以估计，因为其效益可能是分散和延迟的，但在短短几年内，通过更好的个性化治疗，对OCT长达20年的投资已得到多次回报。
