加拿大眼表面生态系统假体置换的经济评估。
Economic appraisal of prosthetic replacement of ocular surface ecosystem in Canada.
机构信息
Faculty of Medicine, University of Toronto, Toronto, ON.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Eye Institute, Toronto, ON.
出版信息
Can J Ophthalmol. 2023 Apr;58(2):143-149. doi: 10.1016/j.jcjo.2021.09.004. Epub 2021 Oct 1.
OBJECTIVE
To perform an economic appraisal of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE; BostonSight, Needham Heights, Mass.) lens in patients with a distorted corneal surface or ocular surface disease in Canada.
DESIGN
Retrospective observational cohort study with cost, cost-utility, and benefit-cost analyses.
PARTICIPANTS
Patients who received PROSE from the only PROSE clinic in Canada from 2018 to 2020.
METHODS
Visual acuity (VA) outcomes of the participants were assessed. Benefits were defined as VA improvements that were converted into utilities and then quality-adjusted life years. Economic values were derived via government statements, clinic financial statements, and published literature.
RESULTS
Average best-corrected VA (BCVA) improvement was -0.42 ± 0.41 logMAR (p = 2.68 × 10) or Snellen 20/53 for the overall cohort, -0.51 ± 0.48 (p = 5.42 × 10) or Snellen 20/65 for distorted corneal surface patients, and -0.31 ± 0.30 (p = 1.30 × 10) or Snellen 20/41 for ocular surface disease patients. This corresponded to discounted quality-adjusted life year gains of 0.51, 0.65, and 0.42, respectively, over an estimated 5-year PROSE device lifespan. Average cost to fit a patient with PROSE was USD$5 469.85 (CAD$7 087.28), of which USD$4 971.38 (CAD$6 441.42) was clinic cost and USD$498.47 (CAD$645.87) was patient cost. Cost-utility was USD$10 256.47 (CAD$13 289.31) for the overall cohort, USD$8 439.79 (CAD$10 935.44) for distorted corneal surface patients, and US$13 069.90 (CAD$16 934.67) for ocular surface disease patients. The benefit-cost ratio was 34.4 for all, 43.8 for distorted corneal surface patients, and 28.3 for ocular surface disease patients.
CONCLUSIONS
Our economic appraisal demonstrated that PROSE treatment provides a significant, cost-effective benefit to Canadian patients with distorted corneal surfaces and ocular surface diseases. This indicates that PROSE clinics are an efficient investment.
目的
在加拿大，对 Prosthetic Replacement of Ocular Surface Ecosystem (PROSE; BostonSight, Needham Heights, Mass.) 透镜在角膜表面变形或眼表疾病患者中的应用进行经济评估。
设计
回顾性观察队列研究，包括成本、成本-效用和效益-成本分析。
参与者
2018 年至 2020 年期间，在加拿大唯一的 PROSE 诊所接受 PROSE 治疗的患者。
方法
评估参与者的最佳矫正视力（BCVA）结果。受益定义为视力改善，转化为效用，然后再转化为质量调整生命年。经济价值通过政府声明、诊所财务报表和已发表文献得出。
结果
总体队列的平均最佳矫正视力（BCVA）改善为-0.42 ± 0.41 logMAR（p=2.68×10）或 Snellen 20/53，角膜表面变形患者为-0.51 ± 0.48（p=5.42×10）或 Snellen 20/65，眼表疾病患者为-0.31 ± 0.30（p=1.30×10）或 Snellen 20/41。这对应于在估计的 5 年 PROSE 设备寿命内，分别获得 0.51、0.65 和 0.42 个质量调整生命年的收益。为每位患者配备 PROSE 的平均成本为 5469.85 美元（7087.28 加元），其中 4971.38 美元（6441.42 加元）为诊所成本，498.47 美元（645.87 加元）为患者成本。总体队列的成本-效用为 10256.47 美元（13289.31 加元），角膜表面变形患者为 8439.79 美元（10935.44 加元），眼表疾病患者为 13069.90 美元（16934.67 加元）。所有患者的效益-成本比为 34.4，角膜表面变形患者为 43.8，眼表疾病患者为 28.3。
结论
我们的经济评估表明，PROSE 治疗为加拿大角膜表面变形和眼表疾病患者提供了显著的、具有成本效益的益处。这表明 PROSE 诊所是一项有效的投资。
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