From the Cullen Eye Institute, Baylor College of Medicine (Leung, Stout, Koch), Houston, Texas, and the Bascom Palmer Eye Institute (Gibbons), University of Miami, Miller School of Medicine, Miami, Florida, USA.
From the Cullen Eye Institute, Baylor College of Medicine (Leung, Stout, Koch), Houston, Texas, and the Bascom Palmer Eye Institute (Gibbons), University of Miami, Miller School of Medicine, Miami, Florida, USA.
J Cataract Refract Surg. 2018 Aug;44(8):971-978. doi: 10.1016/j.jcrs.2018.05.022. Epub 2018 Jul 23.
To determine the cost-effectiveness of intracameral moxifloxacin compared with traditional antibiotic prophylaxis in preventing endophthalmitis after cataract surgery.
Theoretical surgical center in the United States.
Evaluation of technology.
The incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) were calculated for patients having cataract surgery with traditional antibiotic prophylaxis (perioperative topical antibiotics) compared with perioperative topical antibiotics with intracameral moxifloxacin. The base case was a healthy binocular 73-year-old man having first-eye cataract surgery. The incidences and costs were derived from PubMed English literature searches, Medicare reimbursement rates, and average wholesale prices. All costs and benefits were adjusted 3% per annum and for inflation to 2017 United States dollars. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty.
Compared with traditional prophylaxis, an adjuvant 500 μg intracameral moxifloxacin (for $20) was cost-saving from a societal perspective in the base case; in probabilistic sensitivity analyses, all the values were within the societal willingness-to-pay threshold of $50 000/quality-adjusted-life-years (QALYs), and 6142 (61%) of 10 000 iterations were cost-saving. From a healthcare sector perspective, intracameral moxifloxacin was cost-effective, with an ICUR of $8275/QALY. In cases with posterior capsule tears, a $20 intracameral moxifloxacin was cost-saving.
From a societal perspective in the U.S., a topical perioperative antibiotic with a 500 μg intracameral moxifloxacin costing $22 dollars or less was cost-effective and cost-saving. From a healthcare sector perspective, a $20 intracameral moxifloxacin was cost-effective but not cost-saving. Adjuvant intracameral moxifloxacin had greater effectiveness in improving QALYs than topical antibiotics.
评估与传统抗生素预防相比，前房内莫西沙星在预防白内障手术后眼内炎方面的成本效益。
美国理论手术中心。
技术评估。
对接受传统抗生素预防（围手术期局部抗生素）与围手术期局部抗生素联合前房内莫西沙星的患者进行增量成本效益比（ICER）和增量成本效用比（ICUR）计算。基础病例为双眼健康的 73 岁男性，进行第一只眼白内障手术。发病率和成本源自 PubMed 英文文献检索、医疗保险报销率和平均批发价格。所有成本和收益均按每年 3%进行调整，并根据通胀调整至 2017 年的美元。进行确定性和概率敏感性分析以评估不确定性。
与传统预防相比，基础病例中，500μg 前房内莫西沙星（20 美元）作为辅助治疗具有成本效益；在概率敏感性分析中，所有值均在社会愿意支付的 50000 美元/QALY 阈值内，10000 次迭代中有 6142 次（61%）具有成本效益。从医疗保健部门的角度来看，前房内莫西沙星具有成本效益，ICUR 为 8275 美元/QALY。在后囊撕裂的情况下，20 美元的前房内莫西沙星具有成本效益。
从美国社会的角度来看，局部围手术期抗生素联合成本为 22 美元或以下的 500μg 前房内莫西沙星具有成本效益且具有成本节约性。从医疗保健部门的角度来看，20 美元的前房内莫西沙星具有成本效益但不具有成本节约性。辅助前房内莫西沙星在提高 QALY 方面比局部抗生素更有效。
