부산대학교 도서관

PurposeTo determine the most cost-effective case-finding strategy for the ophthalmologist to detect and treat ocular hypertension (OH) and primary open-angle glaucoma (POAG) at an early stage to prevent blindness.DesignA Markov cost-effectiveness simulation model.MethodsThree case-finding strategies are analysed and compared. The simulated cohort consists of all initial patients of at least 40 years old visiting an ophthalmic practice. All patients undergo ophthalmoscopy, but tonometry is routinely performed to: (1) all initial patients, (2) high-risk patients only, or (3) no one. The population characteristics are based on data of 1000 initial patients. Transition probabilities are taken from the literature. The (direct) costs of diagnosis and treatment represent those for the Netherlands. The time-horizon of the model is 20 years. An annual discount rate of 4% is used.Main Outcome MeasuresCosts, proportion of patients becoming blind, years of blindness.ResultsThe costliest strategy (1) leads to least blindness. The incremental cost-effectiveness ratio, which shows extra costs per year of vision saved in comparison to the cheapest strategy (3), is lower for strategy (1) than for strategy (2). It amounts to \[euro]1707, not including extra costs due to blindness (eg associated with the use of disability facilities). When such costs exceed \[euro]1707 per patient per year, which is most likely, then strategy (1) becomes cost saving.ConclusionIt is most cost-effective to routinely perform tonometry to all initial ophthalmic patients to prevent blindness due to glaucoma.Eye (2008) 22, 354–362; doi:10.1038/sj.eye.6702637; published online 24 November 2006 [ABSTRACT FROM AUTHOR]