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Arch Ophthalmol:前列腺素类似物与激光小梁成形术证明治疗青光眼成效

来源:生物谷 2012-02-20 00:10

一项在线发表于Archives of Ophthalmology上的研究,揭示称为前列腺素类似物(PGAs)的青光眼药物治疗与一个小侵入性操作激光小梁成形术(LTP)看起来是新诊断的轻度开放型青光眼病人的成本效益选择。但是,看一下PGAs的当前价格,LTP在坚持服药不是最佳的病例中可能证明更具成本效益。

研究人员得出的结论是,假设坚持服用最佳药物,一般的PAGs比用LTP提供更大的价值。在美国,开角型青光眼(OAG)是一种引起视神经损伤的眼疾,也是不可逆失明的主要原因之一,影响着300多万人。以前的人类试验结果已经表明,高眼压个人发生OAG的风险性通过降低眼内压可被降低。而且,降低眼内压能减小患青光眼病人的疾病进展风险性。眼内压可用局部青光眼药物、切口青光眼手术和LTP来降低。一项成本效益检查是由密歇根大学Joshua D. Stein博士,Ann Arbor和他的研究团队使用数学方法对患有轻度开角型青光眼个人用LTP、PGAs或只观察来开展治疗。

LTP的递增成本效益比不治疗的是16824美元/QALY(quality-adjusted life year,质量调整寿命年)。然而,PGAs的递增成本效益比不治疗的为14179美元/QALY(quality-adjusted life year,质量调整寿命年),并且PGAs提供相对于LTP更大的健康有关生活质量。根据研究人员,如果PGAs因为病人服药遵从性差而效果低于25%,LTP可能是有用的选择。

这项研究发现强调了在决定哪一种干预最具成本效益中服药遵从性的重要性。(生物谷bioon.com)

Cost-Effectiveness of Medications Compared With Laser Trabeculoplasty in Patients With Newly Diagnosed Open-Angle Glaucoma

Joshua D. Stein, David D. Kim, Will W. Peck, Steven M. Giannetti, David W. Hutton

ABSTRACT Objective: To determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP). Methods: Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only. Results: The incremental cost-effectiveness of LTP over no treatment is $16 824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14 179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value. Conclusions: Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.

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