Kobelt G, Jönsson L, Gerdtham U, Krieglstein G K
Health Dynamics International Ltd., France.
Graefes Arch Clin Exp Ophthalmol. 1998 Nov;236(11):811-21. doi: 10.1007/s004170050165.
Economic evaluation of new treatments in the field of glaucoma represents a challenge. In the absence of a clear epidemiological link between intra-ocular pressure (IOP) and disease progression to blindness, the economic impact of treatments that lower IOP on long-term outcome cannot be estimated. As an alternative, effectiveness may be expressed as the ability to control IOP over time, making it possible to estimate the cost-effectiveness of therapies. The objective of this study was to investigate treatment strategies for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) in Germany and to estimate the impact of new topical therapies on the total cost of treatment.
We performed a retrospective analysis of 200 randomly selected patient charts in 50 ophthalmology practices. Demographics, diagnoses, IOP and detailed resource utilization over 2 years were collected. Resources were valued independently from the quantitative data collection, and a standard charge from the perspective of the third party payer, as well as a cost from the societal viewpoint, was determined for each item. A Markov model was created to calculate total treatment costs with the new therapy.
During the 2 years, 54% of patients had their therapy changed at least once. Mean total charge and cost per patient were DM 815 and DM 1274, respectively. Mean IOP at baseline was 31.2 mm at baseline and 18.8 mm after 2 years. IOP at baseline was positively correlated with costs, while IOP reduction after treatment initiation was negatively correlated with costs. Simulations of the effect of new topical therapies on treatment costs to third party payers and to society indicate that a potential reduction or delay of surgical interventions may partly offset the extra cost of the new drugs.
Observational data for glaucoma treatment indicate a high frequency of treatment changes that are associated with higher costs. New treatments that control IOP effectively over time may thus reduce the cost of patient management. Their cost-effectiveness for managing IOP will depend on both, their price and their effectiveness.
青光眼领域新疗法的经济评估是一项挑战。由于眼内压（IOP）与疾病进展至失明之间缺乏明确的流行病学联系，降低IOP的治疗对长期预后的经济影响无法估计。作为一种替代方法，疗效可表示为随时间控制IOP的能力，从而有可能估计治疗的成本效益。本研究的目的是调查德国新诊断为原发性开角型青光眼（POAG）或高眼压症（OH）患者的治疗策略，并估计新局部疗法对治疗总成本的影响。
我们对50家眼科诊所中随机选取的200份患者病历进行了回顾性分析。收集了人口统计学、诊断、IOP以及2年期间详细的资源利用情况。资源估值独立于定量数据收集过程，从第三方支付者的角度确定了每项的标准收费，并从社会角度确定了成本。创建了一个马尔可夫模型来计算采用新疗法的总治疗成本。
在这2年期间，54%的患者至少更换过一次治疗方案。每位患者的平均总收费和成本分别为815德国马克和1274德国马克。基线时的平均IOP为31.2毫米汞柱，2年后为18.8毫米汞柱。基线时的IOP与成本呈正相关，而开始治疗后的IOP降低与成本呈负相关。对新局部疗法对第三方支付者和社会治疗成本影响的模拟表明，手术干预的潜在减少或延迟可能部分抵消新药的额外成本。
青光眼治疗的观察数据表明治疗方案频繁更换与更高的成本相关。随着时间推移能有效控制IOP的新疗法可能会降低患者管理成本。它们在管理IOP方面的成本效益将取决于其价格和疗效。
