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首页> 外文期刊>American Journal of Ophthalmology: The International Journal of Ophthalmology >A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery.
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A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery.

机译：基于价值的医学特发性视网膜前膜手术的成本-效用分析。

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PURPOSE: To perform a reference case, cost-utility analysis of epiretinal membrane (ERM) surgery using current literature on outcomes and complications. DESIGN: Computer-based, value-based medicine analysis. METHODS: Decision analyses were performed under two scenarios: ERM surgery in better-seeing eye and ERM surgery in worse-seeing eye. The models applied long-term published data primarily from the Blue Mountains Eye Study and the Beaver Dam Eye Study. Visual acuity and major complications were derived from 25-gauge pars plana vitrectomy studies. Patient-based, time trade-off utility values, Markov modeling, sensitivity analysis, and net present value adjustments were used in the design and calculation of results. Main outcome measures included the number of discounted quality-adjusted-life-years (QALYs) gained and dollars spent per QALY gained. RESULTS: ERM surgery in the better-seeing eye compared with observation resulted in a mean gain of 0.755 discounted QALYs (3% annual rate) per patient treated. This model resulted in Dollars 4,680 per QALY for this procedure. When sensitivity analysis was performed, utility values varied from Dollars 6,245 to Dollars 3,746/QALY gained, medical costs varied from Dollars 3,510 to Dollars 5,850/QALY gained, and ERM recurrence rate increased to Dollars 5,524/QALY. ERM surgery in the worse-seeing eye compared with observation resulted in a mean gain of 0.27 discounted QALYs per patient treated. The Dollars /QALY was Dollars 16,146 with a range of Dollars 20,183 to Dollars 12,110 based on sensitivity analyses. Utility values ranged from Dollars 21,520 to Dollars 12,916/QALY and ERM recurrence rate increased to Dollars 16,846/QALY based on sensitivity analysis. CONCLUSIONS: ERM surgery is a very cost-effective procedure when compared with other interventions across medical subspecialties.
机译：目的：为了进行参考病例，使用有关结果和并发症的最新文献对视网膜前膜（ERM）手术进行成本-效用分析。设计：基于计算机的，基于价值的医学分析。方法：在两种情况下进行决策分析：视力较好的眼睛进行ERM手术，视力较差的眼睛进行ERM手术。这些模型主要使用来自Blue Mountains眼图研究和Beaver Dam眼图研究的长期公开数据。视敏度和主要并发症来自于25规格的平板玻璃体切除术研究。基于患者的时间权衡效用值，马尔可夫模型，灵敏度分析和净现值调整用于结果的设计和计算。主要结局指标包括获得的折扣质量调整生命年（QALY）数量和获得的每QALY花费的美元。结果：与观察结果相比，在观察力更好的眼睛中进行ERM手术可使每位接受治疗的患者平均获得0.755折扣QALYs（年率3％）。该模型为该过程每个QALY带来4,680美元。进行敏感性分析时，效用值从6,245美元变化为3,746美元/ QALY，医疗成本从3,510美元变化为5,850美元/ QALY，ERM复发率提高到5,524美元/ QALY。与观察结果相比，在观察力较差的眼睛中进行ERM手术可使每位接受治疗的患者平均获得0.27折扣QALYs。根据敏感度分析，美元/ QALY为16,146美元，范围在20,183美元​​至12,110美元之间。根据敏感性分析，效用值从21,520美元到12,916美元/ QALY，ERM重复率增加到16,846美元/ QALY。结论：与跨医学专业的其他干预措施相比，ERM手术是一种非常经济有效的方法。

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