Kobelt-Nguyen G, Gerdtham U G, Alm A
Health Dynamics International, London, United Kingdom.
J Glaucoma. 1998 Apr;7(2):95-104.
The objective of this study was to investigate what treatment strategies prevail in different countries for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) only and initiated on treatment with beta-blockers, and to estimate the total direct cost of treatment for two years. In addition, differences in costs between and within the countries and the determinants of variations in costs across patients were examined.
The authors performed a retrospective medical record analysis in several academic and office-based study centers in Sweden and the United States. Standard costs for each resource item were determined and applied to all centers within the country. Differences in treatment costs within the countries are thus the effect of differences in treatment strategies, not of differences in prices.
There was considerable variation between the centers of each country. Sweden had a higher number of surgical interventions, which may be explained by the fact that the Swedish cohort had a higher mean intraocular pressure (IOP) at baseline and a higher proportion of patients with definite POAG and exfoliation glaucoma. However, in both countries the mean IOP at study end was approximately 18 mm Hg. Total direct costs for two years were 15,119 SEK (US$2,160; $1US = 7 SEK) and $2,109, respectively. In a multiple regression analysis, the estimated effects of baseline IOP and of IOP change after treatment initiation on treatment costs were positively and negatively significant, respectively, in both countries.
Despite differences in baseline diagnosis and in treatment strategies, mean IOP was decreased to 18 mm Hg in both countries. Baseline IOP was positively correlated with treatment costs, while the initial IOP-lowering effect of treatment was negatively correlated with two-year costs.
本研究的目的是调查在不同国家，对于仅新诊断为原发性开角型青光眼（POAG）或高眼压症（OH）且开始使用β受体阻滞剂治疗的患者，何种治疗策略占主导地位，并估算两年的治疗总直接成本。此外，还研究了各国之间以及国家内部的成本差异，以及患者成本差异的决定因素。
作者在瑞典和美国的几个学术及门诊研究中心进行了回顾性病历分析。确定了每个资源项目的标准成本，并应用于国内所有中心。因此，各国国内治疗成本的差异是治疗策略差异的影响，而非价格差异的影响。
每个国家的各中心之间存在相当大的差异。瑞典的手术干预次数较多，这可能是因为瑞典队列在基线时平均眼压较高，且明确诊断为POAG和剥脱性青光眼的患者比例较高。然而，在两个国家，研究结束时的平均眼压均约为18 mmHg。两年的总直接成本分别为15,119瑞典克朗（2,160美元；1美元 = 7瑞典克朗）和2,109美元。在多元回归分析中，基线眼压和治疗开始后眼压变化对治疗成本的估计影响在两个国家分别呈正相关和负相关，且均具有统计学意义。
尽管基线诊断和治疗策略存在差异，但两个国家的平均眼压均降至18 mmHg。基线眼压与治疗成本呈正相关，而治疗的初始降眼压效果与两年成本呈负相关。
