Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Callahan Eye Hospital, Birmingham, Alabama.
Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Ophthalmology. 2022 Oct;129(10):1142-1151. doi: 10.1016/j.ophtha.2022.05.016. Epub 2022 May 28.
To assess the societal cost-utility of the MicroShunt compared with trabeculectomy for the surgical management of glaucoma in the US Medicare system.
Cost-utility analysis using efficacy and safety results of a randomized controlled trial and other pivotal clinical trials.
Markov model cohort of patients with open-angle glaucoma.
Open-angle glaucoma treatment costs and effects were analyzed with a deterministic model over a 1-year horizon using TreeAge software. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. Both treatment arms received additional ocular hypotensive agents to control intraocular pressure (IOP). Treatment effect was measured as mean number of ocular hypotensive medications and reduction in IOP, which had a direct impact on transition probabilities between health states. Analyses of scenarios were performed with longer time horizons. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the impact of alternative model inputs. Both treatment arms were subject to reported complication rates, which were factored in the model.
Incremental cost per quality-adjusted life-year (QALY) gained.
At 1 year, the MicroShunt had an expected cost of US dollars (USD) 6318 compared with USD 4260 for trabeculectomy. MicroShunt patients gained 0.85 QALYs compared with 0.86 QALYs for trabeculectomy, resulting in a dominated incremental cost-utility ratio of USD 187 680. Dominance is a health economic term used to describe a treatment option that is both more costly and less effective than the alternative. The MicroShunt remained dominant in 1-way sensitivity analyses using best-case input parameters (including a device fee of USD 0). At a willingness-to-pay threshold of USD 50 000, the likelihood of the MicroShunt being cost-effective was 6.4%. Dominance continued in longer time horizons, up to 20 years.
Trabeculectomy appears to be a dominant treatment strategy over the MicroShunt in the surgical management of glaucoma. More independent, long-term studies are required for the MicroShunt and other subconjunctival microstent devices to evaluate their use in clinical practice.
评估 MicroShunt 与小梁切除术治疗美国医疗保险体系中青光眼的社会成本效用。
使用随机对照试验和其他关键临床试验的疗效和安全性结果进行成本效用分析。
开角型青光眼的 Markov 模型队列。
使用 TreeAge 软件，在 1 年的时间内，对具有确定性模型的开角型青光眼治疗成本和效果进行分析。健康状况包括 Hodapp-Parrish-Anderson 青光眼分期（轻度、中度、晚期、盲）和死亡。两种治疗方法均接受额外的眼部降压药物来控制眼内压（IOP）。治疗效果的测量标准为平均使用的眼部降压药物数量和 IOP 的降低，这直接影响健康状况之间的转移概率。还对更长的时间范围进行了方案分析。进行了单向敏感性和概率敏感性分析，以评估替代模型输入的影响。两种治疗方法都报告了并发症发生率，并将其纳入模型中。
每获得一个质量调整生命年（QALY）的增量成本。
在 1 年时，MicroShunt 的预期成本为 6318 美元（USD），而小梁切除术的成本为 4260 USD。MicroShunt 患者获得 0.85 个 QALY，而小梁切除术患者获得 0.86 个 QALY，导致增量成本效用比为 187680 美元。主导地位是一个健康经济学术语，用于描述一种治疗方案，其成本高于替代方案，且效果更差。在使用最佳输入参数的单向敏感性分析中（包括 0 美元的设备费用），MicroShunt 仍然占据主导地位。在支付意愿阈值为 50000 美元时，MicroShunt 具有成本效益的可能性为 6.4%。在长达 20 年的时间内，这种主导地位仍在继续。
在青光眼的手术治疗中，小梁切除术似乎是一种优于 MicroShunt 的治疗策略。需要更多独立的、长期的研究来评估 MicroShunt 和其他结膜下微支架设备的使用情况，以评估它们在临床实践中的应用。
