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中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (02) : 94 -98. doi: 10.3877/cma.j.issn.2095-2007.2021.02.006

眼科管理

卫生经济学评价常见致盲眼病筛查的进展
李茹月1, 刘含若2,()   
  1. 1. 100730 首都医科大学附属北京同仁医院2020级硕士研究生
    2. 100730 首都医科大学附属北京同仁医院北京同仁眼科中心 北京市眼科研究所 眼科学与视觉科学北京市重点实验室
  • 收稿日期:2020-12-18 出版日期:2021-04-28
  • 通信作者: 刘含若
  • 基金资助:
    国家自然科学基金项目(81700813); 北京市医院管理局"青苗"计划专项经费项目(QML20180205); 北京市科技新星项目(Z191100001119072); 首都医科大学附属北京同仁医院拔尖人才培养计划,医药协同科研创新研究专项项目(Z181100001918035)

Advances on the health economic evaluation of common blinding eye diseases screening

Ruyue Li1, Hanruo Liu2,()   

  1. 1. Master′s degree 2020, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing 100730, China
  • Received:2020-12-18 Published:2021-04-28
  • Corresponding author: Hanruo Liu
引用本文:

李茹月, 刘含若. 卫生经济学评价常见致盲眼病筛查的进展[J]. 中华眼科医学杂志(电子版), 2021, 11(02): 94-98.

Ruyue Li, Hanruo Liu. Advances on the health economic evaluation of common blinding eye diseases screening[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(02): 94-98.

糖尿病视网膜病变(DR)、青光眼、年龄相关性黄斑变性(AMD)和白内障是全球范围内常见的眼病,也是导致视力障碍和失明的主要原因。目前,已有多个国家或地区从卫生经济学角度评价上述眼病常规筛查的成本效益。但对其单独或联合筛查是否有成本效益尚无明确定论。本文中笔者就近年来国内外眼病筛查的卫生经济学研究进行综述,以期为我国常见致盲眼病的早期筛查提供参考。

Diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD), and cataract are common eye diseases worldwide, and are also the leading causes of visual impairment and blindness. In recent years, many countries and regions have carried out routine screening programs for the above eye diseases, and analyzed cost-effectiveness from the aspect of health economics. Whether screening for them alone or in combination at an early stage is cost-effective has not been determined. The health economic researches of eye diseases screening at home and abroad was summarized, which to provide reference for the early screening of common blinding eye diseases in China.

表1 DR筛查的卫生经济学研究
作者 发表年份(年) 国家 对比方式 分析方法 效果指标 主要结果
Aoki等[12] 2004 美国 远程筛查和常规筛查 CUA 成本或QALYs 远程筛查每增加18.73QALYs成本为16 514美元;常规筛查每增加18.58QALYs成本为17 590美元
Whited等[16] 2005 美国 远程筛查和常规筛查 CEA 总成本 每增加一例接受PRP治疗的患者,成本增加1618美元;每避免一次严重的视力丧失事件,成本增加13 748美元
Li等[17] 2012 美国 远程筛查和常规检查 CBA 直接成本 远程筛查和常规筛查成本分别为49.95美元和77.80美元
Kirkizlar等[13] 2013 美国   CUA 成本或QALYs 当筛查数>3500人,年龄<80岁时,远程筛查对所有种族有成本效益
Richardson等[15] 2013 美国 远程筛查和常规筛查 CMA 节约成本 远程筛查可以避免额外去眼科诊所就诊,每位患者节省153.53美元;需要筛查的患者越多,节省的费用越多
Brady等[14] 2014 美国 远程筛查和不筛查 CMA 节约成本 在基本情况下,远程筛查可为每例患者节省36美元;蒙特卡罗模拟显示,平均每位患者可节省48美元
Phan等[18] 2014 美国 远程筛查和门诊就诊 CMA 直接成本与投资回报的比 平均每台设备屏幕的成本降低了24.3美元,直接成本与投资回报的比为0.47,意味着53%投资成本得到回报。只有15%至少一只眼有DR的患者和20%至少有一幅不可读图像的患者需要转诊进行全面检查
Brown-Connolly等[19] 2014 美国   CUA 直接成本与投资回报的比 投资回报率为15∶1,远程筛查每增加一个QALY节省100万美元
Gomez-Ulla等[20] 2008 西班牙 远程筛查和常规筛查 CBA 直接成本 每位患者使用远程筛查人员、消耗品和设备的成本分别为2.69欧元、0.03欧元及1.62欧元。常规筛查的人员、消耗品和设备的资本成本分别为2.69欧元、0.11欧元及0.33欧元;每位患者有0.97欧元的旅行成本、14.97欧元的收入损失和48.29欧元的会诊费
Romero-Aroca等[21] 2016 西班牙 2.5年筛查和年度筛查 CUA和CEA 成本或QALYs或ICER 每2.5年筛查一次时,成本为(482.85±35.14)欧元/人;对威胁视力的DR患者,成本为(1528.26±114.94)欧元/人。年度筛查时,每位DR患者的QALY增加0.77,ICER为1096.88欧元;每位DR患者的QALY增加0.6,ICER为4571.2欧元
Bjørvig等[22] 2002 挪威 远程筛查和常规筛查 CMA 直接成本 患者数为20人/年时,远程筛查和常规筛查成本分别为8555挪威克朗/人和428挪威克朗/人;患者数为200人/年时,成本分别为971挪威克朗/人和1440挪威克朗/人;患者数为110人/年时,两种筛查方式成本相同
Ben等[23] 2020 巴西 机会性就诊、常规筛查和远程筛查 CUA和CEA 成本或QALYs或ICER 与机会性就诊相比,每挽救1个QALY,远程筛查的增量成本为21 445巴西雷亚尔;常规筛查成本高于远程筛查,且效益更低。在世界卫生组织规定的最低和最高支付意愿门槛下,远程筛查比常规筛查更具成本效益的可能性分别为0.46和0.67
Tung等[25] 2008 中国 筛查和不筛查 CUA和CEA 成本或QALYs或视力挽救年 每隔1、2、3、4及5年筛查一次时,每个视力挽救年的成本分别为20 962新台币、24 990新台币、30 847新台币、37 435新台币及44 449新台币;不筛查组每个视力挽救年的成本为83 411新台币。每隔1、2、3、4及5年筛查一次时,每个成本分别为21 924新台币、25 319新台币、30 098新台币、35 106新台币及40 037新台币;不筛查组每个QALY的成本为61 542新台币
Wu等[24] 2015 中国 筛查和不筛查 CEA 总成本或视力或QALY或ICER 筛查间隔≥4年时,每增加一个QALY ICER<7485美元;每4年筛查一次QALY增量为11.066,且最多
Rachapelle等[26] 2013 印度 一次性筛查、按照不同间隔定期筛查和不筛查 CUA 成本或QALYs 一次性筛查有成本效益,每增加一个QALY成本为1321美元;间隔不超过2年的筛查也有成本效益;年度筛查无成本效益,每增加一个QALY成本为3183美元
[1]
Flaxman SR, Bourne RRA, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990—2020: a systematic review and meta-analysis[J]. The Lancet Global Health, 2017, 5(12): e1221-e1234.
[2]
Sharafeldin N, Kawaguchi A, Sundaram A, et al. Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults[J]. The British Journal of Ophthalmology, 2018, 102(11): 1485-1491.
[3]
黄育北,高鹰,戴弘季,等. 中国城市女性乳腺癌筛查卫生经济学评价[J]. 中国肿瘤临床201946(16): 851-856.
[4]
John D, Parikh R. Cost-effectiveness and cost utility of community screening for glaucoma in urban India[J]. Public Health, 2017, 148: 37-48.
[5]
Müller A, Vu HT, Ferraro JG, et al. Rapid and cost-effective method to assess vision disorders in a population[J]. Clin Exp Ophthalmol, 2006, 34(6): 521-525.
[6]
柳鸿鹏,吴欣娟.国外卫生经济学评价的研究进展[J].中华现代护理杂志202026(24): 3394-3397.
[7]
Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine[J]. JAMA, 2016, 316(10): 1093-1103.
[8]
Shao H, Zhai S, Zou D, et al. Cost-effectiveness analysis of dapagliflozin versus glimepiride as monotherapy in a Chinese population with type 2 diabetes mellitus[J]. Curr Med Res Opin, 2017, 33(2): 359-369.
[9]
Cheung N, Mitchell P, Wong TY. Diabetic retinopathy[J]. Lancet, 2010, 10, 376(9735): 124-136.
[10]
Dwyer MS, Melton LJ, Ballard DJ, et al. Incidence of diabetic retinopathy and blindness: a population based study in Rochester Minnesota[J]. Diabetes Care, 1985, 8: 316-322.
[11]
Yau JW, Rogers SL, Kawasaki R, et al. Meta-Analysis for Eye Disease (META-EYE) Study Group. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564.
[12]
Aoki N, Dunn K, Fukui T, et al. Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population[J]. Diabetes Care, 2004, 27(5): 1095-1101.
[13]
Kirkizlar E, Serban N, Sisson JA, et al. Evaluation of telemedicine for screening of diabetic retinopathy in the Veterans Health Administration[J]. Ophthalmology, 2013, 120: 2604-2610.
[14]
Brady CJ, Villanti AC, Gupta OP, et al. Tele-ophthalmology screening for proliferative diabetic retinopathy in urban primary care offices: an economic analysis[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45: 556-561.
[15]
Richardson DR, Fry RL, Krasnow M. Cost-savings analysis of telemedicine use for ophthalmic screening in a rural Appalachian health clinic[J]. West Virginia Medical Journal, 2013, 109(4): 52-55.
[16]
Whited JD, Datta SK, Aiello LM, et al. A modeled economic analysis of a digital teleophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy[J]. Telemed J E Health, 2005, 11: 641-651.
[45]
Magnusson G, Persson U. Screening for congenital cataracts: A cost-consequence analysis of eye examination at maternity wards in comparison to well-baby clinics[J]. Acta Paediatrica, 2005, 94(8): 1089-1095.
[46]
Chew EY, Schachat AP. Should we add screening of age-related macular degeneration to current screening programs for diabetic retinopathy?[J]. Ophthalmology, 2015, 122(11): 2155-2156.
[47]
Dimock J, Robman LD, McCarty CA, et al. Cost- effectiveness of digital cataract assessment[J]. Aust NZ Ophthalmol, 1999, 27: 208-210.
[48]
van Leeuwen R, Chakravarthy U, Vingerling JR, et al. Grading of age-related maculopathy for epidemiological studies: is digital imaging as good as 35-mm film? [J].Ophthalmology, 2003, 110: 1540-1544.
[49]
Gangwani R, Lai WW, Sum R, et al. The incidental findings of age-related macular degeneration during diabetic retinopathy screening[J]. Graefes Arch Clin Exp Ophthalmol, 2014, 252: 723-729.
[50]
Hu CC, Ho JD, Lin HC, et al. Association between open-angle glaucoma and neovascular age-related macular degeneration: a case-control study[J]. Eye (London, England), 2017, 31(6): 872-877.
[51]
Gangwani RA, McGhee SM, Lai JS, et al. Detection of glaucoma and its association with diabetic retinopathy in a diabetic retinopathy screening program[J]. Glaucoma, 2016, 25(1): 101-105.
[17]
Li Z, Wu C, Olayiwola JN, et al. Telemedicine-based digital retinal imaging vs standard ophthalmologic evaluation for the assessment of diabetic retinopathy[J]. Conn Med, 2012, 76: 85-90.
[18]
Phan AD, Koczman JJ, Yung CW, et al. Cost analysis of teleretinal screening for diabetic retinopathy in a county hospital population[J]. Diabetes Care, 2014, 37: e252-e253.
[19]
Brown-Connolly NE, Concha JB, English J. Mobile health is worth it! Economic benefit and impact on health of a population-based mobile screening program in new Mexico[J]. Telemed J E Health, 2014, 20: 18-23.
[20]
Gomez-Ulla F, Alonso F, Aibar B, et al. A comparative cost analysis of digital fundus imaging and direct fundus examination for assessment of diabetic retinopathy[J]. Telemed J E Health, 2008, 14: 912-918.
[21]
Romero-Aroca P, de la Riva-Fernandez S, Valls-Mateu A, et al. Cost of diabetic retinopathy and macular oedema in a population, an eight year follow up[J]. BMC Ophthalmology, 2016, 16: 136.
[22]
Bjørvig S, Johansen MA, Fossen K. An economic analysis of screening for diabetic retinopathy[J]. Telemed Telecare, 2002, 8: 32-35.
[23]
Ben AJ, Neyeloff JL, de Souza CF, et al. Cost-utility analysis of opportunistic and systematic diabetic retinopathy screening strategies from the perspective of the brazilian public healthcare system[J]. Appl Health Econ Health Policy, 2020, 18(1): 57-68.
[24]
Wu B, Li J, Wu H. Strategies to screen for diabetic retinopathy in chinese patients with newly diagnosed type 2 diabetes: a cost-effectiveness analysis[J]. Medicine (Baltimore), 2015, 94(45): e1989.
[25]
Tung TH, Shih HC, Chen SJ, et al. Economic evaluation of screening for diabetic retinopathy among Chinese type 2 diabetics: a community-based study in Kinmen, Taiwan[J]. Epidemiology, 2008, 18(5): 225-233.
[26]
Rachapelle S, Legood R, Alavi Y, et al. The cost-utility of telemedicine to screen for diabetic retinopathy in India[J]. Ophthalmology, 2013, 120(3): 566-573.
[27]
Vijan S, Hofer TP, Hayward RA. Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus[J]. JAMA, 2000, 283(7): 889-896.
[28]
Rein DB, Wittenborn JS, Zhang X, et al. The cost-effectiveness of three screening alternatives for people with diabetes with no or early diabetic retinopathy[J]. Health Serv Res, 2011, 46(5): 1534-1561.
[29]
Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040[J]. Ophthalmology, 2014, 121: 2081-2090.
[30]
Moyer VA, U.S. Preventive Services Task Force. Screening for glaucoma: U.S. Preventive Services Task Force Recommendation Statement[J]. Ann Intern Med, 2013, 159(7): 484-489.
[31]
U.S. Preventive Services Task Force. Screening for glaucoma: recommendation statement[J]. Ann Fam Med, 2005, 3(2): 171-172.
[32]
Rein DB, Wittenborn JS, Lee PP, et al. The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open-angle glaucoma in the United States[J]. Ophthalmology, 2009, 116: 823-832.
[33]
Burr JM, Mowatt G, Hernandez R, et al. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation[J]. Health Technol Assess, 2007, 11: 110-190.
[34]
Harasymowycz P, Fansi KA, Papamatheakis D. Screening for primary open-angle glaucoma in the developed world: are we there yet? [J].Can Ophthalmol, 2005, 40(4): 477-86.
[35]
John D, Parikh R. Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model[J]. Public Health, 2018, 155: 142-151.
[36]
Tang JJ, Liang YB, O′Neill C, et al. Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model[J]. The Lancet Global Health, 2019, 7(7): e968-e978.
[37]
Thomas S, Hodge W, Malvankar-Mehta M. The cost-effectiveness analysis of teleglaucoma screening device[J]. PLoS One, 2015, 10(9): e0137913.
[38]
Swierk T, Jürgens C, Grossjohann R, et al. Health economical aspects of telemedical glaucoma monitoring[J]. Ophthalmologe, 2011, 108(4): 342-350.
[39]
Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis[J]. Lancet Glob Health, 2014, 2: e106-e116.
[40]
Rein DB, Zhang P, Wirth KE, et al. The economic burden of major adult visual disorders in the United States[J]. Arch Ophthalmol, 2006, 124(12): 1754-1760.
[41]
Hopley C, Salkeld G, Wang JJ, et al. Cost utility of screening and treatment for early age related macular degeneration with zinc and antioxidants[J]. Br J Ophthalmol, 2004, 88(4): 450-454.
[42]
Chan CK, Gangwani RA, McGhee SM, et al. Cost-effectiveness of screening for intermediate age-related macular degeneration during diabetic retinopathy screening[J]. Ophthalmology.2015, 122(11): 2278-2285.
[43]
Ra H, Song LD, Choi JA, et al. The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea[J]. PloS one, 2018, 13(10): e0206690.
[44]
Tamura H, Goto R, Akune Y, et al. The clinical effectiveness and cost-effectiveness of screening for age-related macular degeneration in Japan: A Markov Modeling Study[J]. PloS One, 2015, 10(7): e0133628.
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