Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
Ophthalmology. 2020 Jul;127(7):859-865. doi: 10.1016/j.ophtha.2020.01.049. Epub 2020 Jan 31.
To determine the cost effectiveness of an adjunctive screening OCT during the preoperative evaluation of a patient considering cataract surgery with a multifocal intraocular lens (IOL) implantation.
Cost-effectiveness analysis.
A 67-year-old man with 20/60 vision undergoing evaluation for first-eye cataract surgery.
The cost-effectiveness analysis of the reference patient undergoing a preoperative cataract examination with and without a screening OCT was performed, evaluating for vitreoretinal diseases including an epiretinal membrane, age-related macular degeneration, vitreomacular traction, and cystoid macular edema. It was assumed that patients with macular pathologies detected before surgery would receive a monofocal IOL and be referred to a retina specialist for evaluation and management. The Medicare reimbursable cost of an OCT was $41.81. All costs and benefits were adjusted for inflation to 2019 United States dollars and discounted 3% per annum over a 16-year time horizon. Probability sensitivity analyses and 1-way deterministic sensitivity analyses were performed to assess for uncertainty.
Incremental cost-effectiveness ratio and incremental cost-utility ratio (ICUR) measured in quality-adjusted life years (QALYs).
Approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be detected on the initial clinical examination. In the base case, an adjunctive preoperative OCT was cost effective from a third-party payer and societal perspective in the United States. In the probability sensitivity analyses, the ICURs were within the societal willingness-to-pay threshold of $50 000/QALY in approximately 64.4% of the clinical scenarios.
A preoperative screening OCT during the evaluation of a patient considering a multifocal IOL added to the costs of the cataract surgery, but the OCT increased the detection of macular pathologies and improved the QALYs over time. An adjunctive screening OCT can be cost effective from a third-party payer and societal perspective.
确定在考虑行多焦点人工晶状体（IOL）植入的白内障手术的患者术前评估中附加辅助性 OCT 检查的成本效益。
成本效益分析。
一位 67 岁男性，视力为 20/60，正在接受第一只眼白内障手术评估。
对参考患者进行了术前白内障检查，并评估了是否进行辅助性 OCT 检查，以发现包括视网膜前膜、年龄相关性黄斑变性、玻璃体黄斑牵引和囊样黄斑水肿在内的眼后段疾病。假设在术前发现黄斑病变的患者将接受单焦点 IOL，并转介给视网膜专家进行评估和管理。OCT 的医疗保险可报销费用为 41.81 美元。所有成本和效益均根据通胀调整为 2019 年的美元，并在 16 年的时间内按每年 3%贴现。进行概率敏感性分析和 1 种确定性敏感性分析以评估不确定性。
增量成本效益比和增量成本效用比（ICUR），以质量调整生命年（QALY）衡量。
大约 20.5%接受白内障手术的患者可能患有黄斑病变，其中 11%可能无法在初始临床检查中发现。在基础病例中，在美国，附加术前 OCT 从第三方支付者和社会角度来看是具有成本效益的。在概率敏感性分析中，在大约 64.4%的临床情况下，ICUR 处于社会愿意支付的 50000 美元/QALY 的阈值内。
在考虑多焦点 IOL 的患者评估中进行术前辅助性 OCT 检查会增加白内障手术的成本，但 OCT 增加了黄斑病变的检出率，并随着时间的推移提高了 QALY。从第三方支付者和社会角度来看，附加的筛查性 OCT 可以具有成本效益。
