摘要
目的:应用成本—效果分析的原理进行评价原发性闭角型青光眼不同筛检试验组成的筛检方案,从中选择出最优方案。方法:根据文献及我们研究的结果建立筛检模型及模型计算所需的参数,然后将手电筒侧照法、前房轴深、周边前房深度及手电筒侧照十周边前房深度串联法这四种筛检方法引入筛检模型的计算机程序进行计算,得出各种筛检方案筛检、诊断和治疗的成本;筛检出的病人多获得的质量调整寿命年。在这个基础上进行各种筛检方案的成本—效果分析。并改变部分参数作灵敏度分析,根据每增加一个质量调整寿命年需要成本最少或节约医疗费用最多为优选原则,选择出最优方案。结果:显示无论哪个年龄组,手电筒侧照十周边前房深度的串联筛检方案是每增加一个质量调整寿命年成本花费最少的方案,故为最优方案,手电筒侧照法作为筛检试验的筛检方案为次优方案。这两个方案对40岁～<70岁人群的原发性闭角型青光眼的筛检不但可以增加质量调整寿命年,而且可以节约医疗费用。灵敏度分析结果:除了当人群中窄房角高危者比例上升或下降到10％时,70岁以上年龄组的串联筛检方案从最优变为次优外,其余均显示手电筒侧照法十周边前房深度测量的串联筛检方案为最优方案。结论:研究显示手电筒侧照十周边前房深度测量的串联筛检方案为最优方?
Purpose:To evaluate various primary angle clouse glaucoma(PACG)screening strategies by cost effectiveness analysis for choosing the best screening strategy. Methods:We designed a model of the process of PACG screening, diagnosis, treatment, and estimated variable parameters of this model through literatures reviewed and the results of our study. Then four screening strategiers which are oblique flashlight test, measurement of axial anterior chamber depth (AACD).examination of peripheral anterior chamber depth (PACD), and combination of oblique flashlight test with examination of PACD in series were calculated by computer to obtain the costs for various screening strategies and the quality ajusted life years (QALYs) saved. We performed sensitivity analysis to determine how the variation in the parameter assumptions would affect the calculated cost effectiveness of the various screening strategies. Based on the principle of cost effectiveness, the screening straregy of more cost effective would be chosen.
Results: The results showed that no matter what age group, the screening strategy of oblique flashlight test and measuring PACD combined in seriesis the lowest cost per QALY gained than other strategies. This screening strategy is optimum, next is oblique flashlight test Screening method. We found that screening strategies not only gains QALY,but also is cost saving as well in the range 40 - < 70 years old. sensitively analysis result showed that optimum strategy is still the combined serial strategy, in addition to the capable closure angle ratio of apopulation with a 10% up and down, the oblique flashlight test became an optimum strategy and the combined serial method became next in ≥70 years old group.
Conclusion :The results showed that the oblique flashlight test and measurement of PAGD combined in series is an optimum screening strategy. This research suggests that using adequate screening strategy should not only increase the QALYs, but also save the cost for the government and the patients themselves. Eye Science 1997; 13 : 202-209.
出处
《眼科学报》
1997年第4期202-209,共8页
Eye Science
