원발개방각녹내장에서 추적관찰 주기에 따른 비용효용분석
Cost-utility Analysis of Primary Open-angle Glaucoma according to Follow-up Observation Period
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목적: 녹내장의 추적관찰 주기와 녹내장의 진행 정도의 정량적 관계에 기초한 비용효용분석을 시행하고자 하였다. 대상과 방법: Markov 모델을 구축하여 초기 녹내장을 가지고 있는 40세 이상의 한국인 남녀를 가상의 코호트로 설정하였다. 녹내장치료 관련 비용을 사회적인 관점에서 파악하였으며, 효용은 녹내장 상태에 따른 질보정수명을 산출하였다. 녹내장 건강상태는 5단계로 나누었다(초기, 중기, 후기, 단안실명, 양안실명). 녹내장 상태의 전이는 경도에서 중등도로 한 방향으로만 전이하는 것으로 하였고, 각 한 주기의 길이는 1년으로 설정하였다. 비용효용의 점진적 증가비율을 계산하여 추적관찰 주기에 따른 비용효용을 비교하였다. 민감도 분석을 시행하여 본 연구에서 사용한 변수의 불확실성이 어떻게 결과에 영향을 주는지를 파악하였다. 결과: 3개월 추적관찰의 점진적 비용효용비는 6개월의 추적관찰 대비 질보정수명당 28,244,398원이며, 6개월 추적관찰의 점진적 비용효용비는 12개월 추적관찰 대비 질보정수명당 13,615,443원으로 나타났다. 3개월 대비 6개월 주기 추적관찰의 진행확률이 약 10% 이상 증가하고, 3개월 대비 12개월 추적관찰의 진행확률이 약 15% 이상 증가하는 경우에는 3개월 주기 추적관찰이 비용효과적인 것으로 나타났다. 반면, 3개월 대비 6개월 추적관찰의 진행확률의 증가폭이 10% 미만이고, 3개월 대비 12개월 추적관찰의 진행확률이 15% 이상 증가할 경우 6개월 추적관찰이 비용효과적인 것으로 나타났다. 3개월 대비 6개월 추적관찰 전략의 진행확률 증가폭이 10%를 넘고, 3개월 대비 12개월 추적관찰의 진행확률 증가폭이 15% 미만이면 12개월 추적관찰이 비용효과적인 것으로 나타났다. 결론: 본 연구에서 녹내장의 진행확률에 따라 비용효과적인 추적관찰의 전략이 다르며, 3개월 또는 6개월의 추적관찰 전략이 비용효과적이며 우리나라의 의료보건체계에서 받아들일 수 있는 정도인 것으로 나타났다.
Abstract
Purpose: To evaluate the cost-utility based on the quantitative relationship between glaucoma follow-up and glaucoma progression. Methods: The Markov model was constructed and analyzed to determine the cost-effectiveness of primary open-angle glaucoma. The Markov model set up a virtual cohort of Korean over 40 years of age with early glaucoma. The costs associated with glaucoma treatment were assessed from a social point of view, and the utility was calculated using the quality adjusted life years according to the glaucoma states. Glaucoma health status was divided into 5 stages (early, middle, late, unilateral, bilateral blindness). The transition probability was set in one direction from mild to severe, and the length of each cycle was set at one year. The incremental cost effectiveness ratio (ICER) was calculated and compared with each other different follow-up periods. Sensitivity analysis was conducted to determine how the uncertainty of the variables used in this study affected the outcome. Results: ICER of 3-month follow-up was 28,244,398 won/quality adjusted life years (QALY) compared 6-month follow-up, and ICER of 6-month follow-up was 13,615,443 won/QALY compared to 12-month follow-up. If the probability of progression of glaucoma in 6-months follow-up observations increases by more than 10% over 3-month periodic follow-up and the progression probability of 12-month follow-up increases by more than 15% follow-up compared to 3-months follow-up, 3-months follow-up was found to be a cost-effective strategy. On the other hand, 6-month follow-up was found to be cost-effective if probability of progression of 6-month follow-up was less than 10% increase of 3-month follow-up and 15% increase of 6-months follow-up. Conclusions: Cost-effective follow-up strategies differed according to the probability of progression of glaucoma, and 3-month or 6-month follow-up strategies were cost-effective and acceptable in Korea's health care system.
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