Hangjian Wu, Gus Gazzard, Anthony King, James Morgan, David Wright, David P Crabb, Yemisi Takwoingi, Augusto Azuara-Blanco, Verity Watson, Rodolfo Hernández
{"title":"基于风险预测工具监测眼压的成本效益。","authors":"Hangjian Wu, Gus Gazzard, Anthony King, James Morgan, David Wright, David P Crabb, Yemisi Takwoingi, Augusto Azuara-Blanco, Verity Watson, Rodolfo Hernández","doi":"10.1136/bmjophth-2024-001741","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367344/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cost-effectiveness of monitoring ocular hypertension based on a risk prediction tool.\",\"authors\":\"Hangjian Wu, Gus Gazzard, Anthony King, James Morgan, David Wright, David P Crabb, Yemisi Takwoingi, Augusto Azuara-Blanco, Verity Watson, Rodolfo Hernández\",\"doi\":\"10.1136/bmjophth-2024-001741\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background/aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":9286,\"journal\":{\"name\":\"BMJ Open Ophthalmology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367344/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open Ophthalmology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjophth-2024-001741\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/bmjophth-2024-001741","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景/目的评估英国根据风险预测(RP)工具对眼压过高(OHT)患者做出治疗决定的成本效益:方法:建立离散事件模拟模型,比较替代治疗路径的成本效益,在替代治疗路径中,二级医疗机构的治疗决策由经过验证的 RP 工具指导,而二级医疗机构的决策则基于标准治疗(SC)。该研究采用了患者个体抽样的方法。确诊为 OHT 且眼压大于或等于 24 mm Hg 的患者在进入模型时,需要预先确定一组与其转化为青光眼的风险相关的个体特征。这些特征来自电子病历(n=5740)。在转为青光眼后,对青光眼的不同阶段进行建模:几乎所有患者(99%)都接受了 RP 策略治疗,只有不到一半的患者(47%)接受了 SC 策略治疗。RP策略的成本高于SC策略,但质量调整生命年(QALY)也高于SC策略。在基础病例分析中,RP 策略与 SC 策略相比具有成本效益,增量成本效益比值为 11522 英镑。在每 QALY 临界值为 20 000 英镑的情况下,RP 策略的成本效益概率为 96%:结论:使用 RP 工具治疗 OHT 患者可能具有成本效益。结论:使用RP工具对OHT患者进行管理可能具有成本效益,但由于该队列的高风险性质和研究中使用的特定RP阈值,结果的普遍性可能受到限制。
Cost-effectiveness of monitoring ocular hypertension based on a risk prediction tool.
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.
Methods: 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.
Results: 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.
Conclusions: 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.