孔源性视网膜脱离手术的成本效用分析

Cost-utility Analysis of Rhegmatogenous Retinal Detachment Surgery

目的对孔源性视网膜脱离的手术治疗进行成本效用分析。方法对在上海交通大学附属第一人民医院眼科施行手术治疗的117名孔源性视网膜脱离的患者进行为期1年的随访,收集其手术相关的费用,并用时间权衡法得到患者手术前后的效用值,以3%的贴现率计算期望寿命时间内获得的质量调整生命年。以空白干预为对照,采用Bootstrap法进行增量成本效用分析,计算每额外获得一个质量调整生命年需要增加的成本,即增量成本效果比。变化主要参数,对结果进行单因素敏感性分析。结果孔源性视网膜脱离手术干预的平均成本为8471元(95%可信区间7716～9227元),平均额外获得的质量调整生命年为1.24(95%可信区间0.73～1.76),每额外获得1个质量调整生命年需要增加的成本为6819元(95%可信区间4711～11816元)。其中行巩膜扣带手术者每额外获得1个质量调整生命年需要增加的成本为4892元(95%可信区间3366～8971元),行玻璃体手术者每额外获得1个质量调整生命年需要增加的成本为17134元(95%可信区间8824～73110元)。结论对孔源性视网膜脱离患者施行手术治疗能够获得更多的质量调整生命年,每额外获得1个质量调整生命年需要6819元。

Objective To perform a cost-utility analysis of rhegmatogenous retinal detachment （RRD） surgery. Methods Data of 117 patients who underwent RRD surgeries were collected in Shanghai First People＇s Hospital, Affiliated Shanghai Jiaotong University, and were followed up for at least one year. Costs associated with surgery were recorded. Utility values of RRD surgery were obtained by using time trade-off （Tro） method, and quality-adjusted life years （QALYs） were calculated using the patients＇ life expectancy at 3% discounted rate. Incremental cost-utility analysis was performed （as compared to no treatment） by calculating incremental cost-effectiveness ratio （ICER）, which means the mean incremental cost for each QALY. Bootstrap method was used to make statistical analysis, and one-way sensitivity analyses were performed to test robustness of the results. Results Mean incremental cost of RRD surgery was RMB 8 471 yuan [95% confidence interval（CI） 7 716-9 227 yuan], mean additional QALY gained was 1.24 （95%CI 0.73-1.76）, and the incremental cost for each additional QALY was RMB 6 819 yuan （95%CI 4 711- 11 816 yuan）, among which, for scleral buckling surgery, the incremental cost for each additional QALY was RMB 4 892 yuan （95%CI 3 366-8 971 yuan）, and for vitreous surgery, the incremental cost for each additional QALY was RMB 17 134 yuan （95%CI 8 824-73 110 yuan）. Conclusion For RRD patients, the surgery does help them obtain more quality-adjusted life years, and the incremental costs for each QALY gained are 6 819 yuan.