开发一种辅助青光眼手术管理的计算机化和自动化成本效益分析应用。

IF 1.8 4区 医学 Q2 OPHTHALMOLOGY
Journal of Glaucoma Pub Date : 2025-06-01 Epub Date: 2025-03-04 DOI:10.1097/IJG.0000000000002557
Jaideep Prasad, Shefali Sood, Lama A Al-Aswad
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引用次数: 0

摘要

精确:在本文中,我们描述了经过验证的软件的开发,该软件基于对先前文献中讨论的青光眼进展和管理的稳健数学模型的修改,可以自动进行微创青光眼手术的成本效益分析。目的:在美国微创青光眼手术(MIGS)的临床管理和调查中,开发一种有效的应用程序,以简化成本效益(CE)的使用。设计:自动化成本效用分析改编自马尔可夫模型描述在先前的文献。参与者:年龄在65岁及以上的轻度至中度原发性开角型青光眼患者,不考虑并发明显的白内障。方法:在已有微创小梁网支架CE模型的基础上,构建模拟青光眼37种状态进展及死亡的Markov模型。这些状态代表了不同青光眼严重程度(轻度、中度、晚期和严重/失明)的组合,临床治疗方法不同,包括使用多达4种药物、选择性激光小梁成形术或切口手术。这些并不是相互排斥的,而是基于与视网膜神经纤维层变薄的速率有关的决定。新的转移概率不是针对特定的手术干预使用固定的转移概率,而是根据与视野平均偏差下降相关的眼压预期降低动态地推导出来的。除了通用的MIGS组外,还包括两个比较组(白内障手术组或仅用药组)。药物减量、总成本和效用是模型中可修改的输入。最优和最坏的结果由简单或复杂(需要二次手术干预/药物依从性)干预结果决定。该模型在R中完全重新实现,并通过将结果与TreeAge数据进行比较来验证。主要结局指标:总成本、质量调整生命年(QALY)和增量成本-效果比(ICER)。结果:一项针对Hydrus和iStent注射装置植入的35年最佳病例ce分析提供了与先前数据相似的成本和QALY值(R与TreeAge): Hydrus(成本:50446.53美元对48026.13美元;质量:12.18对12.26),iStent注射(成本:52323.43美元对49599.86美元;质量:12.13对12.21),白内障(成本:54150.56美元对54409.25美元;质量:12.03 vs. 12.04)。随着时间的推移,ICER的趋势也非常相似。结论:新型软件可用于帮助MIGS的CE分析,具有可修改的输入和感兴趣的结果。这种工具使CE更容易用于临床管理决策,并可能指导未来的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development of a Computerized and Automated Cost-Effectiveness Analysis Application to Aid in Glaucoma Surgical Management.

Prcis: In this article, we describe the development of validated software that automates cost-effectiveness analyses of minimally invasive glaucoma surgeries based on modifications to robust mathematical models of glaucoma progression and management discussed in previous literature.

Purpose: To develop a validated application to streamline the use of cost-effectiveness (CE) in clinical management and investigations of minimally invasive glaucoma surgeries (MIGS) in the US.

Design: Automated cost-utility analysis adapted from Markov models described in prior literature.

Participants: Patients of ages 65 years and older with mild to moderate primary open angle glaucoma irrespective of concurrent visually significant cataract.

Methods: Markov models simulating glaucoma progression through 37 states and death were constructed based on previous CE models of minimally invasive trabecular meshwork stents. These states represent combinations of various glaucoma severity (mild, moderate, advanced, and severe/blind) with differences in clinical management, including the use of up to 4 medications, selective laser trabeculoplasty, or incisional surgery. These are not mutually exclusive and are based on decisions related to the rate of thinning of the retinal nerve fiber layer. Rather than using fixed sets of transition probabilities for specific surgical interventions, new transition probabilities are dynamically derived based on the expected reduction in intraocular pressure related to visual field mean deviation decline. In addition to the generic MIGS arm, 2 comparison arms (cataract-surgery or medications-only) are included. Medication reduction, whole costs, and utilities are modifiable inputs in the model. Optimal and worst-case results are determined by uncomplicated or complicated (secondary surgical intervention required/medication nonadherence) intervention outcomes. The model was entirely re-implemented in R and validated by comparing results to TreeAge data.

Main outcome measures: Total costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER).

Results: An optimal-case 35-year CE-analysis of the implantation of Hydrus and iStent inject devices provided values of costs and QALY that were similar to prior data (R vs. TreeAge): Hydrus (Cost: $50,446.53 vs. $48,026.13; QALY: 12.18 vs. 12.26), iStent inject (Cost: $52,323.43 vs. $49,599.86; QALY: 12.13 vs. 12.21), cataract (Cost: $54,150.56 vs. $54,409.25; QALY: 12.03 vs. 12.04). Trends of ICER over time were also very similar.

Conclusions: Novel software is available to aid in CE analyses of MIGS with modifiable inputs and outcomes of interest. Such a tool makes CE more accessible for use in clinical management decisions and may guide future investigation.

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来源期刊
Journal of Glaucoma
Journal of Glaucoma 医学-眼科学
CiteScore
4.20
自引率
10.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Glaucoma is a peer reviewed journal addressing the spectrum of issues affecting definition, diagnosis, and management of glaucoma and providing a forum for lively and stimulating discussion of clinical, scientific, and socioeconomic factors affecting care of glaucoma patients.
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