Angell Blake, Ali Ferhina, Gandhi Monica, Mathur Umang, Friedman David S, Jan Stephen, Keay Lisa
The George Institute for Global Health, University of NSW Sydney, Newtown, New South Wales, Australia.
Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
BMJ Open Ophthalmol. 2018 Feb 9;3(1):e000123. doi: 10.1136/bmjophth-2017-000123. eCollection 2018.
Ready-made spectacles have been suggested as a less resource-intensive treatment for the millions of people living with uncorrected refractive error (URE) in low-income environments. In spite of this interest, there have been no published economic evaluations examining the cost-effectiveness of ready-made spectacles. This study aims to determine the relative cost-effectiveness of offering ready-made spectacles (RMS) relative to no intervention as well as the relative cost-effectiveness of custom-made spectacles (CS) relative to RMS to treat URE.
The relative cost-effectiveness of RMS relative to CS and no intervention was tested through a cost-effectiveness analysis from the health service provider perspective conducted alongside a double-masked randomised controlled trial in an urban hospital in Delhi, India. Participants were adults aged 18-45 years with ≥1 dioptre (D) of URE.
There was no significant difference between the effectiveness of the CS and RMS interventions in improving visual acuity, but the CS was over four times the price of the RMS per patient (204 INR (US$2.42) and 792 INR (US$11.22)). The cost per unit improvement in logarithm of the minimum angle of resolution (logMAR) relative to baseline with the RMS intervention was 407 INR (US$4.35). Existing estimates of utility resulting from improvements in visual acuity result in incremental cost per quality-adjusted life years gained of between 212 INR and 1137 INR (US$0.44-US$23.74) depending on the source of the utility estimate and assumed expected life of the spectacles.
RMS represent a significantly cost-effective option for spectacle provision in low-resource settings. The RMS programme was substantially cheaper than an equivalent CS intervention while being effective in improving visual acuity for the majority of adults with refractive error in this setting. These findings provide further support for including RMS in programmes to address URE.
NCT00657670, Results.
对于低收入环境中数百万患有未矫正屈光不正（URE）的人，成品眼镜被认为是一种资源消耗较少的治疗方法。尽管有这种关注，但尚未有已发表的经济评估来检验成品眼镜的成本效益。本研究旨在确定提供成品眼镜（RMS）相对于不干预的相对成本效益，以及定制眼镜（CS）相对于RMS治疗URE的相对成本效益。
通过从卫生服务提供者角度进行的成本效益分析，在印度德里的一家城市医院进行的双盲随机对照试验中，测试了RMS相对于CS和不干预的相对成本效益。参与者为年龄在18 - 45岁、URE≥1屈光度（D）的成年人。
CS和RMS干预在提高视力方面的效果没有显著差异，但CS的价格是每位患者RMS的四倍多（分别为204印度卢比（2.42美元）和792印度卢比（11.22美元））。RMS干预相对于基线的每单位最小分辨角对数（logMAR）改善成本为407印度卢比（4.35美元）。根据视力改善带来的效用估计来源以及眼镜的预期使用寿命，现有视力改善带来的效用估计导致每获得一个质量调整生命年的增量成本在212印度卢比至1137印度卢比之间（0.44美元至23.74美元）。
在资源匮乏地区，RMS是提供眼镜的一种显著具有成本效益的选择。RMS方案比同等的CS干预便宜得多，同时在改善该环境中大多数患有屈光不正的成年人的视力方面是有效的。这些发现为将RMS纳入解决URE的方案提供了进一步支持。
NCT00657670，结果
