Bartelt-Hofer Jose, Ben-Debba Lilia, Flessa Steffen
Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
Dauphine University, Paris, France.
Pharmacoecon Open. 2020 Mar;4(1):5-12. doi: 10.1007/s41669-019-0141-4.
Our objective was to review, compare and gain insight into economic evaluations in primary open-angle glaucoma (POAG) with a focus on existing decision analytic models.
A literature review was performed using clinical and specialized databases following best practices. Relevant inclusion criteria included the development of a decision analytic model, the assessment of POAG interventions, and a full economic evaluation in terms of costs and health-related outcomes. Model inputs and settings were extracted, compared and analyzed. Main study incremental outcomes were also reported.
The literature review identified 22 full articles in alignment with the eligibility criteria for a total of 15 countries and a wide range of years from 1983 to 2018. Interventions included as competing alternatives in the eligible studies were topical medications (33%), screening or diagnosis (33%), surgical interventions (10%), laser trabeculoplasty (10%) and minimally invasive surgeries (3%). Markov models using transition states were the most common type of modeling approach. Cost-utility models using a mid- to long-term time horizon with a national payer perspective were the most frequent type of economic evaluation identified. Model states commonly included disease severity levels, as defined by glaucoma staging systems, and other relevant events such as blindness and death. Authors did not sufficiently justify key modeling assumptions, inputs or the robustness of their findings.
Decision analytic models in POAG can reasonably guide future modeling research by revealing common practices, inputs and assumptions. Furthermore, this review revealed evidence gaps in terms of unexplored interventions and treatment sequences.
我们的目的是回顾、比较并深入了解原发性开角型青光眼（POAG）的经济评估，重点关注现有的决策分析模型。
按照最佳实践，使用临床和专业数据库进行文献综述。相关纳入标准包括决策分析模型的开发、POAG干预措施的评估以及成本和健康相关结果方面的全面经济评估。提取、比较并分析模型输入和设置。还报告了主要研究的增量结果。
文献综述确定了22篇符合纳入标准的完整文章，涉及总共15个国家，时间跨度从1983年到2018年。符合条件的研究中作为竞争替代方案的干预措施包括局部用药（33%）、筛查或诊断（33%）、手术干预（10%）、激光小梁成形术（10%）和微创手术（3%）。使用过渡状态的马尔可夫模型是最常见的建模方法类型。从国家支付方角度采用中长期时间范围的成本效用模型是确定的最常见的经济评估类型。模型状态通常包括青光眼分期系统定义的疾病严重程度水平以及失明和死亡等其他相关事件。作者没有充分说明关键建模假设、输入或其研究结果的稳健性。
POAG中的决策分析模型可以通过揭示常见做法、输入和假设，合理地指导未来的建模研究。此外，本综述揭示了在未探索的干预措施和治疗序列方面的证据空白。
