拉坦、曲伏及比马前列素治疗青光眼的成本效用分析

目的：评估拉坦前列素，曲伏前列素和比马前列素在挪威，瑞典及丹麦（斯堪的纳维亚）治疗开角型青光眼的成本效用。方法：建立马尔可夫卫生经济学决策分析模型，评估比较前列腺素类似物的成本效用。健康状态为稳定及进展期青光眼。原发性开角型青光眼和表皮剥脱性青光眼的转换概率均由发表的医学文献数据计算所得。通过对分散遍及于各国家的45位眼科医生进行调查获得临床医疗模式。各国家的具体单位成本包括药费，就诊费，诊断及治疗费。生命质量权重值指定为视力0．50～0．84，时间范围为5a。所有分析均为付款人观点成本效益分析，成本结果每年降低3％。结果：在挪威和瑞典，拉坦前列素较曲伏前列素和比马前列素费用低而效益高，拉坦前列素比其他药物费用低达4％。在丹麦，所有三种药物的费用在彼此的1．5％之内，比马前列素与曲伏前列素费用相当，而较拉坦前列素费用略低，但是拉坦前列素较曲伏前列素和比马前列素效益高。各国家所有药物的效用在一个窄范围内。结论：在斯堪的纳维亚，拉坦前列素为其他可买到的前列腺素类似物提供了经济有效的替代物。

Cost-effectiveness of latanoprost, travoprost and bimatoprost for the treatment of glaucoma in Norway, Sweden and Denmark, using a decision-analytic health economic model

AIM： To evaluate the cost-effectiveness of latanoprost, travoprost and bimatoprost monotherapy in open angle glaucoma in Norway, Sweden and Denmark（Scandinavia）. METHODS： A Markov decision-analytic health economic model was developed to estimate the comparative costeffectiveness of prostaglandin analogs. Health states were stable and progressed glaucoma. Transition probabilities for both primary open angle and exfoliation glaucoma were populated with data from published medical literature. Clinical practice patterns were derived from surveys obtained from 45 ophthalmologists dispersed throughout each country. Specific unit costs for each country were used for medications, clinic visits, diagnostics and therapies. Quality-of-life weights were assigned for visual acuity from 0.50-0.84. The time horizon was five years. All analyses were from a payer perspective and cost results were discounted at 3% per annum. RESULTS： Latanoprost was less expensive and more effective than bimatoprost and travoprost in both Norway and Sweden. Latanoprost was up to 4% less expensive in Sweden and Norway and the costs of all three medicines were within 1.5% of each other in Denmark. In Denmark bimatoprost dominated travoprost and was slightly less expensive than latanoprost while latanoprost was more effective than bimatoprost or travoprost. Effectiveness was within a narrow range for all products in each country. CONCLUSION： Latanoprost provides a cost-effective alternative to other available prostaglandin analogs in Scandinavia.