北京地区小梁消融术与Schlemm管成形术卫生经济学评价及预算影响分析

Analysis on the health economics evaluation and budget impact of trabectome and canaloplasty in Beijing

目的对小梁消融术、Schlemm管成形术进行卫生经济学评价以及对小梁消融术申请物价进行预算影响分析。设计卫生经济学评价。研究对象2022年2月北京大学第三医院行抗青光眼日间手术治疗并于门诊完成12个月随访的原发性开角型青光眼患者3例。方法评价的效果指标采用手术成功率;评价的成本指标采用手术及术后12个月内随访的直接医疗成本。小梁消融术对比Schlemm管成形术采取最小成本分析法,小梁消融术与Schlemm管成形术分别对比复合式小梁切除术采用成本效果分析法、计算增量成本效果比。根据Schlemm管成形术和复合式小梁切除术的手术量,以及小梁消融术申请物价后的替代情况,结合三种手术的例均总费用进行预算影响分析,计算小梁消融术申请物价前后各类手术总费用的差别。主要指标手术成功率、直接医疗成本、增量成本效果比。结果小梁消融术和Schlemm管成形术的例均总费用分别为13729元和28793元,小梁消融术比Schlemm管成形术低15064元。以复合式小梁切除术的单例均总费用14281元为参考,小梁消融术的增量成本效果比为-87.6元,Schlemm管成形术的增量成本效果比为767.8元。预期小梁消融术申请物价后至少可替代50%的复合式小梁切除术和Schlemm管成形术,医院年总费用将节省384080元。结论在北京地区,小梁消融术比Schlemm管成形术、复合式小梁切除术治疗原发性开角型青光眼更具有成本效果;小梁消融术申请物价定价后,可使青光眼手术治疗的相关总费用得到节约。

Objective To conduct health economic evaluation analysis for trabectome,canaloplasty and to analyze the budget impact of applying for prices of trabectome.Design health economics evaluation.Participants 3 patients diagnosed as primary open-angle glaucoma that underwent day case anti-glaucoma surgery in February 2022 with completed 12-months-follow-up in Peking University Third Hospital.Methods The evaluated effectiveness was measured by the success rate of the surgical procedures.The evaluated cost was the direct medical costs of surgeries and post operationally follow-up within 12 months.The minimum cost analysis was used to compare trabectome with canaloplasty,while the cost-effectiveness analysis was used by calculating the incremental cost-effectiveness ratio(ICER)to compare both trabectome and canaloplasty with trabeculectomy,respectively.The difference in total costs of various types of surgery before and after the price application for trabectome was calculated based on the amount of canaloplasty and trabeculectomy,as well as the substitution of trabectome.Main Outcome Measures Success rate of the surgical procedures,direct medical costs,ICER.Results The total cost per case for trabectome and canaloplasty was￥13729 and￥28793,respectively,which showed an￥15064 decrease in cost from tebectome to canaloplasty.Using the total cost per case of￥14281for trabeculectomy as a reference,the ICER was-￥87.6 for trabectome and￥767.8 for canaloplasty.Prospectively replacing at least 50%of canaloplasty and trabeculectomy with trabectome,the total cost of the hospital was saved by￥384080 annually.Conclusion In Beijing,trabectome was more cost-effective than canaloplasty and trabeculectomy for primary open-angle glaucoma.The total costs of surgical treatment relevant for primary open-angle glaucoma could be saved after the price of trabectome was applied.