Nowak-Gospodarowicz Izabela, Gospodarowicz Marcin, Rękas Marek
Department of Ophthalmology, Military Institute of Medicine - National Research Institute, 128 Szaserow St, 04-141, Warsaw, Poland.
Institute of Banking, Warsaw School of Economics, Niepodległości 162, 02-554, Warsaw, Poland.
Health Econ Rev. 2024 Apr 27;14(1):30. doi: 10.1186/s13561-024-00506-6.
There are no standards in diagnostic and therapeutic approaches to eye care in incomplete eyelid closure due to unresolved facial palsy (FP). Loading of the upper eyelid (UELL) with gold weights (GWs) or platinum chains (PCs) is a highly effective procedure for the correction of lagophthalmos. Despite this, the procedure is used infrequently in our country because of the relatively high price of the implant and the lack of reimbursement. The aim of this research was to assess the factors influencing medical expenditures in this group of patients and to analyze utility costs for the UELL procedure with the use of GW and PC compared to tarsorrhaphy.Material and methods The costs of 88 surgical procedures (40 GWs, 11 PCs and 37 tarsorrhaphies) and medical expenditures before and after surgery were calculated based on reporting of materials, staff salaries and the SF-36 questionnaire. Distribution quartiles of the cost per QALY measure (dependent variable) was assessed via an ordered logistic regression model with eight explanatory variables.Results The calculated total cost of the surgery was US$209 for tarsorrhaphy, US$758 for UELL with a GW and US$1,676 for UELL with a PC. Bootstrapped costs per QALY values (CUI) in 88% of cases were below the US$100,000 cutoff. Etiology and duration of facial palsy and presence of Bell's phenomenon were factors that significantly influenced the CUI. Patient gender and age, history of previous eyelid surgery, and presence of corneal sensation were found to be not significant (p > 0.1). Calculated ICER for GW was US$1,241.74/1QALY and ICER for PC was US$13,181.05/1QALY compared to tarsorrhaphy.Conclusions Eye protection in patients with FP should be a crucial element of health policy. Findings suggest UELL procedure with a GW or a PC to be a cost-effective procedure with GW being the most cost-effective.
对于因面神经麻痹（FP）未得到解决而导致眼睑闭合不全的眼部护理，目前尚无诊断和治疗方法的标准。用上睑负重（UELL）法植入金重（GW）或铂链（PC）是矫正兔眼症的一种非常有效的方法。尽管如此，由于植入物价格相对较高且缺乏报销，该方法在我国使用并不频繁。本研究的目的是评估影响该组患者医疗费用的因素，并分析与睑裂缝合术相比，使用GW和PC进行UELL手术的效用成本。材料和方法 根据材料报告、员工工资和SF - 36问卷，计算了88例外科手术（40例GW、11例PC和37例睑裂缝合术）的成本以及手术前后的医疗费用。通过具有八个解释变量的有序逻辑回归模型评估每质量调整生命年（QALY）测量成本（因变量）的分布四分位数。结果 计算得出睑裂缝合术的手术总成本为209美元，UELL植入GW的手术总成本为758美元，UELL植入PC的手术总成本为1676美元。在88%的病例中，自抽样得到的每QALY值成本（CUI）低于100,000美元的临界值。面神经麻痹的病因、持续时间以及贝尔现象的存在是显著影响CUI的因素。发现患者的性别和年龄、既往眼睑手术史以及角膜感觉的存在不具有显著性（p＞0.1）。与睑裂缝合术相比，计算得出GW的增量成本效果比（ICER）为1241.74美元/1QALY，PC的ICER为13181.05美元/1QALY。结论 对面神经麻痹患者的眼部保护应是卫生政策的关键要素。研究结果表明，UELL手术使用GW或PC是一种具有成本效益的方法，其中GW是最具成本效益的。
