cost-effectiveness of internal limiting membrane peeling 内界膜剥离的成本效益

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1、Cost-effectivenessofinternallimitingmembranepeelingversusnopeelingforpatientswithidiopathicfullthicknessmacularhole:resultsfromarandomisedcontrolledtrial.LauraTernent1LukeVale1CharlesBoachie2JenniferBurr2NoemiLois3fortheFull-thicknessmacularholeandInternalLimitingMembranepeelingStudy(FILMS)Group1Ins

2、tituteofHealth&Society,NewcastleUniversity,UK2HealthServicesResearchUnit,UniversityofAberdeen,UK3OphthalmologyDepartment,GrampianUniversityHospitals-NHSTrust,Aberdeen,UKAddressforcorrespondence:LauraTernent,InstituteofHealth&Society,BaddileyClarkeBuilding,NewcastleUniversityNE24AXTel:01922227083Fax:

3、01912226043E-mail:laura.ternent@ncl.ac.ukWordcount:246817AbstractPurpose:Todeterminewhetherinternallimitingmembrane(ILM)peelingiscost-effectivecomparedwithnopeelingforpatientswithidiopathicstage2or3full-thicknessmacularhole(FTMH).Methods:Acost-effectivenessanalysiswasperformedalongsidearandomisedcon

4、trolledtrial(RCT).141participantswererandomlyallocatedtoreceivemacularholesurgery,witheitherILMpeelingornopeeling.Healthserviceresourceuse,costsandqualityoflifewerecalculatedforeachparticipant.Incrementalcostperquality-adjustedlifeyear(QALY)gainedwascalculatedat6months.Results:At6monthstotalcostswer

5、eonaveragehigher(£424,95%CI-182to1045)intheNoPeelarm;primarilyduetothehigherreoperationrateintheNoPeelarm.ThemeanadditionalQALYsfromILMpeelatsixmonthswere0.002(95%CI0.01to0.013),adjustingforbaselineEQ-5Dandotherminimisationfactors.AmeanincrementalcostperQALYwasnotcomputedasPeelingwasonaveragelesscos

6、tlyandslightlymoreeffective.Astochasticanalysissuggestedthattherewasmorethana90%probabilitythatPeelingwouldbecost-effectiveatawillingnesstopaythresholdof£20,000perQALY.Conclusion:AlthoughthereisnoevidenceofastatisticallysignificantdifferenceineithercostsorQALYsbetweenmacularholesurgerywithorwithoutI

7、LMpeeling,thebalanceofprobabilitiesisthatILMPeelingislikelytobeacost-effectiveoptionforthetreatmentofmacularholes.Furtherlong-termfollow-updataisneededtoconfirmthesefindings.17INTRODUCTIONAfull-thickn