目标:当前的成本效益分析(CEA)强调药物成本是NICE推荐的抗VEGF治疗之间的区别,但可能忽略了在英国运行nAMD服务的实际非药物成本。为了解决这个问题,这项研究确定了与英国NHSnAMD诊所相关的真实世界非药物服务成本项目,包括运营压力(需求超过产能)引起的成本。方法:通过对同行评审和灰色文献的结构化文献综述来确定成本项目,以及由10位英国眼科医生组成的专家小组,与现实世界的实践有关。这些项目进行了荟萃合成,然后在共识练习中确定。结果:在确定的237个成本项目中,217(91.6%)达到>0.51的共识阈值,并被纳入nAMD服务非药物成本工具(nAS)。使用nAS作为参考标准从英国卫生技术评估(HTA)中获取的成本项目的敏感性较低(HTAmin:1.84%,95%CI0.50-4.65%;HTAmax:70.51%,95%CI63.96-76.49%)。假阴性率显示出根据患病率按成本负担对服务进行错误分类的可能性。使用成本大小的情景分析估计,每位患者的年度诊所成本为845英镑(在能力范围内)至13,960英镑(在压力下),而HTAmin的估计为210英镑。在假设的推广方案中,在假定的卫生资源利用率增加50%的情况下,考虑应变成本会影响成本效益。结论:研究结果表明,HTA低估了英国NHSnAMD临床成本负担,菌株的成本会导致大量额外的未测量费用,并影响CEA。鉴于紧张可能导致的治疗不足,由于在影响英国眼科服务的有限容量条件下的稳健性,耐用度被认为是nAMD抗VEGF治疗CEA的相关因素之一.
当考虑治疗效果如何与花费多少时,通常只关注药品本身的价格。然而,其他现实世界的成本存在。在英国,在治疗某些眼部问题时,例如新生血管性年龄相关性黄斑变性(nAMD),还有与运营诊所和管理治疗相关的额外费用,这些费用往往被忽视。为了更好地了解这些隐藏的成本,该研究调查了诊所工作量和随之而来的额外费用等因素。咨询了英国的十名眼科医生的专家意见,并审查了许多研究论文以确定这些额外费用。该研究将不同的成本分组在一个名为nAMD服务非药物成本工具(nAS)的工具中。当将NAS工具的结果与通常的成本计算方法进行比较时,发现传统方法忽略了许多实际费用。繁忙的诊所面临独特的挑战,例如与延长工作时间的人员配备相关的更高的运营成本,紧急预约,延长的等待时间和错过最佳治疗窗口的可能性。这可能导致疾病进展和合并症的发作,这需要更复杂和昂贵的治疗。在做出有关治疗的决定时,认识到这些实际成本至关重要,特别是当治疗需要更频繁地访问眼科诊所时。这项研究强调了考虑所有费用的重要性,在确定最有效的方法来管理像英国的nAMD这样的眼部疾病时,不仅仅是像药物和医生访问这样明显的方法。
UNASSIGNED: Current cost-effectiveness analyses (CEA) emphasize drug costs as the differentiator between NICE recommended anti-VEGF treatments but may neglect real-world non-drug costs of running nAMD services in the UK. To address this, this study identified real-world non-drug service cost items relevant to UK NHS nAMD clinics, including costs arising from operational strain (demand exceeding capacity).
UNASSIGNED: Cost items were identified by a structured literature
review of peer-reviewed and grey literature, and an expert panel of 10 UK-based ophthalmologists with relevance to real-world practice. These items underwent meta-synthesis and were then determined in a consensus exercise.
UNASSIGNED: Of 237 cost items identified, 217 (91.6%) met the consensus threshold of >0.51 and were included in the nAMD Service Non-Drug Cost Instrument (nAS). Sensitivity of cost items taken from UK Health Technology Assessment (HTA) using the nAS as the reference standard was low (HTAmin: 1.84%, 95% CI 0.50-4.65%; HTAmax: 70.51%, 95% CI 63.96-76.49%). False negative rates showed variable likelihood of misclassifying a service by cost burden depending on prevalence. Scenario analysis using cost magnitudes estimated annual per-patient clinic cost at £845 (within capacity) to £13,960 (under strain) compared to an HTAmin estimate of £210. Accounting for cost of strain under an assumed 50% increase in health resource utilization influenced cost-effectiveness in a hypothetical genericisation scenario.
UNASSIGNED: Findings suggested that HTA underestimates UK NHS nAMD clinic cost burden with cost of strain contributing substantial additional unmeasured expense with impact on CEA. Given potential undertreatment due to strain, durability is suggested as one of the relevant factors in CEA of nAMD anti-VEGF treatments due to robustness under limited capacity conditions affecting UK ophthalmology services.
When considering how well treatments work versus how much they cost, the focus is usually only on the price of the medicine itself. However, other real-world costs exist. In the UK, when treating certain eye problems such as neovascular age-related macular degeneration (nAMD), there are additional expenses related to running clinics and managing treatments that often go unnoticed. To get a better understanding of these hidden costs, the study examined factors like clinic workload and the extra expenses that come with it. Ten eye doctors in the UK were consulted for their expert opinions and numerous research papers were reviewed to identify these additional costs. The study grouped different costs in a tool called the nAMD Service Non-Drug Cost Instrument (nAS). When the findings of the nAS tool were compared to the usual methods of calculating costs, it was found that the conventional approach overlooked many of the actual expenses. Busy clinics face unique challenges, such as higher operational costs associated with staffing for extended hours, emergency appointments, extended waiting times and the potential to miss optimal treatment windows. This can lead to disease progression and the onset of comorbidities, which require more complex and costly treatments. Recognizing these real costs is crucial when making decisions about treatments, especially when treatments require more frequent visits to eye clinics. This study emphasizes the importance of considering all expenses, not just the obvious ones like medication and doctor visits when determining the most effective way to manage eye conditions like nAMD in the UK.