원발개방각녹내장 환자에서 일차 치료 방법에 따른 비용과 분포 비교
Economic Evaluation of Different Initial Treatments for Primary Open Angle Glaucoma: A Markov Model
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목적: 한국의 실정에서 녹내장 환자에게 초기 치료로 약물, 레이저 또는 수술적 치료를 선택하였을 때 시간에 따라 각각의 치료에소요되는 비용과 환자의 분포를 알아보았다. 대상과 방법: 세 가지 초기 치료에 대해 각각 독립적인 Markov process를 만들어 Markov model을 제작하고 시간에 따른 상태들의확률적인 분포를 나타냈다. 1 stage를 1년으로 정의하고 5, 10, 20년 동안의 비용을 Monte Carlo Simulation을 통해 구하였다. 결과: 5년을 기준으로, 레이저를 초기 치료로 선택할 경우에 가격이 가장 낮았고 10년을 기준으로는 수술을 초기 치료로 선택할 경우에 가격이 가장 낮았다. 10년을 기준으로 수술 성공률이 30.1% 이상이면 수술을 초기 치료로 선택하는 것이 약물치료보다 경제적이고레이저를 초기 치료로 선택할 경우, 레이저 성공률이 16.3% 이상이면 약물치료보다 경제적이다. 약제값이 연간 약 5만 5천원, 6만원이하로 내려가야 각각 수술과 레이저 치료보다 경제적일 수 있다. 결론: 레이저섬유주성형술은 단기간(5년) 동안에 비용 대 효율이 우수하고 수술은 장기간(10년 이상)에 걸쳐 비용 대 효율이 우수하다.
Abstract
Purpose: To perform an economic evaluation of the different treatment methods available for primary open-angle glaucoma in a Korean setting,including medication, selective laser trabeculoplasty, or surgery. Methods: Three independent Markov chains were constructed for each treatment option to simulate treatment progress and to evaluate the total treatment costs for each initial strategy. The Markov chain consisted of different stages (5, 10, 20 stages), with each stage being one year. Assuming 1000 patients, a Monte Carlo simulation was iterated 1000 times to evaluate the cost of treatment over 5, 10 and 20 years. Results: During the initial five years, medication as the initial treatment was the most expensive, whereas laser trabeculoplasty was the cheapest. After ten years, surgery became the cheapest treatment. In ten years, if the success rate of surgery is greater than 30.1%, it was more economic to choose surgery as the initial treatment. For laser trabeculoplasty, if the success rate was greater than 16.3%, laser treatment was more economical than was medication. Our model shows that only if the annual cost of medication decreases to 60,000 won or 55,000won, then the cost of choosing medication as the initial treatment strategy will be more economical than that of laser therapy or surgery,respectively. Conclusions: The economic value of choosing laser therapy as the initial treatment strategy is the greatest over five simulated-years, whereas surgery had the greatest economic value over more than ten years.
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