Feldman Robert M, Cioffi George A, Liebmann Jeffrey M, Weinreb Robert N
The University of Texas Medical School Houston, TX, USA.
Department of Ophthalmology, NewYork Presbyterian Hospital Columbia University Irving Medical Center, NY, New York, USA.
Clin Ophthalmol. 2020 Mar 6;14:729-739. doi: 10.2147/OPTH.S236030. eCollection 2020.
Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians' knowledge and attitudes about cost-effectiveness in glaucoma treatment.
This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of cost-effectiveness decisions; the clinical utility of cost-effectiveness studies; and the cost-effectiveness of available treatments.
Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions.
Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identified medications, diagnostics, office visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decision-making but identified the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to efficacy, participants felt patient adherence and side-effect profile should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context.
Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater efficacy and favorable side-effect and adherence profiles may help optimize cost-effectiveness. Future studies should include: clinicians' perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model.
不断上涨的医疗成本促使人们持续努力降低成本。为了帮助降低与开角型青光眼（OAG）相关的成本，OAG是一种普遍存在的、渐进性疾病，会产生大量直接和间接成本，临床医生需要了解降低眼压（IOP）药物治疗的成本效益。关于临床医生对青光眼治疗成本效益的知识和态度，几乎没有公开信息。
这项试点焦点小组研究旨在探讨临床医生对青光眼治疗成本及成本驱动因素的态度和观点；成本效益决策的实施；成本效益研究的临床实用性；以及现有治疗方法的成本效益。
六位美国青光眼专家参加了两次单独的电话会议（每次三位参与者），由一位独立的、经验丰富的主持人（也是一位青光眼专家）使用讨论指南进行主持。参与者在会议前阅读了最近关于青光眼健康经济学结果研究的25篇出版物。
参与者对青光眼治疗的经济负担有清晰的认识，并将药物、诊断、门诊就诊和治疗变更确定为关键成本驱动因素。他们认为成本效益是治疗决策的一个适当组成部分，但指出需要更多数据来为这些决策提供依据。参与者表示，最近关于青光眼健康经济学结果的研究很少，这些研究评估对患者护理很重要的参数，如生活质量和药物依从性，而且纵向数据很少。除了疗效外，参与者认为患者依从性和副作用情况也应纳入青光眼药物治疗的经济评估中。在此背景下对最近批准的药物进行了评估。
临床医生认为基于成本效益数据的治疗决策在临床上是合适的。具有潜在更高疗效、有利副作用和依从性的新型降眼压疗法可能有助于优化成本效益。未来的研究应包括：临床医生的观点；缺乏商业偏见；长期结果/成本分析；更全面的参数；真实世界（包括生活质量）数据；以及强大的马尔可夫模型。
