Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
BMJ Open Ophthalmol. 2024 Aug 28;9(1):e001741. doi: 10.1136/bmjophth-2024-001741.
BACKGROUND/AIMS: To assess the cost-effectiveness of making treatment decisions for patients with ocular hypertension (OHT) based on a risk prediction (RP) tool in the United Kingdom.
A discrete event simulation model was constructed to compare the cost-effectiveness of an alternative care pathway in which the treatment decision was guided by a validated RP tool in secondary care against decision-making based on the standard care (SC). Individual patient sampling was used. Patients diagnosed with OHT and with an intraocular pressure of 24 mm Hg or over entered the model with a set of predefined individual characteristics related to their risk of conversion to glaucoma. These characteristics were retrieved from electronic medical records (n=5740). Different stages of glaucoma were modelled following conversion to glaucoma.
Almost all (99%) patients were treated using the RP strategy, and less than half (47%) of the patients were treated using the SC strategy. The RP strategy produced higher cost but also higher quality-adjusted life years (QALYs) than the SC strategy. The RP strategy was cost-effective compared with the SC strategy in the base-case analysis, with an incremental cost-effectiveness ratio value of £11 522. The RP strategy had a 96% probability of being cost-effective under a £20 000 per QALY threshold.
The use of an RP tool for the management of patients with OHT is likely to be cost-effective. However, the generalisability of the result might be limited due to the high-risk nature of this cohort and the specific RP threshold used in the study.
背景/目的：评估在英国，基于风险预测（RP）工具为眼压升高（OHT）患者做出治疗决策的成本效益。
构建了一个离散事件模拟模型，以比较一种替代护理途径的成本效益，该途径在二级护理中通过验证的 RP 工具指导治疗决策，而另一种途径则基于标准护理（SC）做出决策。采用个体患者抽样。患有 OHT 且眼压为 24mmHg 或以上的患者进入模型时，具有一组与他们向青光眼转化的风险相关的预设个体特征。这些特征从电子病历中检索（n=5740）。模拟了向青光眼转化后的不同阶段的青光眼。
几乎所有（99%）患者都使用 RP 策略进行治疗，而只有不到一半（47%）的患者使用 SC 策略进行治疗。RP 策略产生的成本更高，但也产生了更高的质量调整生命年（QALYs）。与 SC 策略相比，RP 策略在基础分析中具有成本效益，增量成本效益比为 11522 英镑。在 20000 英镑/QALY 的阈值下，RP 策略有 96%的可能性具有成本效益。
使用 RP 工具管理 OHT 患者可能具有成本效益。然而，由于该队列的高风险性质和研究中使用的特定 RP 阈值，结果的普遍性可能有限。
