近视患病率的上升是一个主要的全球公共卫生问题。近视干预措施的经济评估对于最大限度地提高治疗和医疗保健系统的效益至关重要。本系统综述旨在评估治疗近视的干预措施的成本效益。搜索了五个数据库-Embase,Emcare,PubMed,WebofScience,和ProQuest-从成立到2022年7月,总共确定了2099篇文章。经过仔细评估,6项研究符合资格标准。这项系统评价的主要结果是成本,质量调整生命年(QALYs),和增量成本效益比(ICER)。次要结果包括效用值和净货币收益(NMB)。一项研究确定了光折变筛查加0.01%阿托品治疗的成本效益,2项研究检查了角膜屈光手术的成本效益,3项研究评估了病理性近视常用疗法的成本效益。角膜屈光手术包括激光原位角膜磨镶术(LASIK),飞秒激光辅助原位角膜磨镶术(FS-LASIK),屈光性角膜切除术(PRK),和小切口透镜提取(SMILE)。病理性近视的干预措施包括雷珠单抗,conbercept,和光动力疗法(PDT)。以每人18新西兰元(95%CI15,20)(11美元)的增量成本计算,光折变筛查加0.01%阿托品的ICER为1,590NZ$/QALY(1,001美元/QALY)(95%CINZ$1,390,1,791),增量QALY为0.0129(95%CI0.0127,0.0131).欧洲屈光手术的费用从3,075欧元到3,123欧元不等([4,046美元到4,109美元-根据2021年的通货膨胀调整)。与这些程序相关的QALY为23(FS-LASIK)和24(SMILE和PRK),效用值为0.8,ICER的范围约为14欧元(17美元)/QALY至19欧元(23美元)/QALY。LASIK的ICER为683美元/屈光度(经通胀调整)。雷珠单抗和PDT的ICER分别为8,778英镑(12,032美元)/QALY和322,460美元/QALY,conbercept节省了541,974人民币(80,163美元)/QALY,分别。使用0.01%阿托品和角膜屈光手术治疗近视具有成本效益。雷珠单抗和康柏西普治疗病理性近视比PDT更具成本效益。预防近视进展比治疗病理性近视更具成本效益。
The rising prevalence of myopia is a major global public health concern. Economic evaluation of myopia interventions is critical for maximizing the benefits of treatment and the healthcare system. This systematic
review aimed to evaluate the cost-effectiveness of interventions for treating myopia. Five databases were searched - Embase, Emcare, PubMed, Web of Science, and ProQuest - from inception to July 2022 and a total of 2,099 articles were identified. After careful assessments, 6 studies met the eligibility criteria. The primary outcomes of this systematic
review were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The secondary outcomes included utility values and net monetary benefits (NMB). One study determined the cost-effectiveness of photorefractive screening plus treatment with 0.01% atropine, 2 studies examined cost-effectiveness of corneal refractive surgery, and 3 studies evaluated cost-effectiveness of commonly used therapies for pathologic myopia. Corneal refractive surgeries included laser in situ keratomileusis (LASIK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), photorefractive keratectomy (PRK), and small-incision lenticule extraction (SMILE). Interventions for pathologic myopia included ranibizumab, conbercept, and photodynamic therapy (PDT). At an incremental cost of NZ$ 18 (95% CI 15, 20) (US$ 11) per person, photorefractive screening plus 0.01% atropine resulted in an ICER of NZ$ 1,590/QALY (US$ 1,001/QALY) (95% CI NZ$ 1,390, 1,791) for an incremental QALY of 0.0129 (95% CI 0.0127, 0.0131). The cost of refractive surgery in Europe ranged from €3,075 to €3,123 ([US$4,046 to $4,109 - adjusted to 2021 inflation). QALYs associated with these procedures were 23 (FS-LASIK) and 24 (SMILE and PRK) with utility values of 0.8 and ICERs ranging from approximately €14 (US$17)/QALY to €19 (US$23)/QALY. The ICER of LASIK was US$683/diopter gained (inflation-adjusted). The ICER of ranibizumab and PDT were £8,778 (US$12,032)/QALY and US$322,460/QALY respectively, with conbercept yielding a saving of 541,974 RMB (US$80,163)/QALY, respectively. The use of 0.01% atropine and corneal refractive surgery were cost-effective for treating myopia. Treating pathologic myopia with ranibizumab and conbercept were more cost-effective than PDT. Prevention of myopia progression is more cost-effective than treating pathologic myopia.