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Klin Monbl Augenheilkd 2005; 222(2): 110-116
DOI: 10.1055/s-2004-813905
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Kosteneffektivität von Screening auf Amblyopie

Cost-effectiveness of Screening for AmblyopiaA. S. Neubauer1 , S. Neubauer2
  • 1Augenklinik, Ludwig-Maximilians-Universität, München
  • 2IfG, Institut für Gesundheitsökonomik, München
Further Information

Publication History

Eingegangen: 19.5.2004

Angenommen: 26.11.2004

Publication Date:
17 February 2005 (online)

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Zusammenfassung

Hintergrund: Die Effektivität eines Screenings auf Amblyopie wird seit vielen Jahren kontrovers diskutiert. Während der medizinische Nutzen bewiesen ist, liegen zur Frage der Kosteneffektivität nur beschränkte Daten vor. Methoden: Mittels Literatursuche wurden die Variablen abgegrenzt, die für ein Modell zur Kosteneffektivität wichtig sind: Häufigkeit der Amblyopie, Sensitivität verschiedener Screening-Modalitäten, Effektivität der Therapie, deren Kosten sowie der Verlust an Lebensqualität durch eine bestehende Amblyopie. Anschließend wurden hieraus die Kosten für ein Screening pro qualitätsbereinigtes Lebensjahr (QALY) errechnet. Dieses Ergebnis wurde mittels Sensitivitätsanalyse auf seine Stabilität geprüft und in den Kontext anderer Therapien gestellt, um die gefundenen Werte besser beurteilen zu können. Ergebnisse: Die Inzidenz der Amblyopie liegt bei mindestens 2 % (1,3 - 12 %). Die meisten Screening-Programme erreichen eine Sensitivität von 60 - 90 %, wobei sich die Kosten pro erkannten Fall auf etwa 900 - 1400 € belaufen. Mit einer Therapie kann bei Kosten von etwa 2300 € in ca. 60 % der Fälle ein Gebrauchsvisus von mindestens 0,5 erreicht werden, wobei jedoch die Ergebnisse stark streuen. Mit diesen Daten ergeben sich diskontierte Kosten für Screening und Therapie von 7684 €/QALY, was im Bereich anderer als effizient akzeptierter Therapien liegt. In der Sensitivitätsanalyse ergeben sich ungünstigstenfalls 24 700 €/QALY bzw. 57 633 €/QALY bei erhöhter Diskontierung. Schlussfolgerung: Ein Screening auf Amblyopie erfüllt die Grundvoraussetzung der Kosteneffektivität.

Abstract

Background: The effectiveness of a screening program for amblyopia has been discussed controversely for several years. While the medical profit is obvious, little is known on the cost-effectiveness of such a screening program. Methods: By literature research all important variables were determined: incidence of amblyopia, sensitivity of different screening modalities, effectiveness of therapy, costs as well as the loss of utility and life quality by an existing amblyopia. Based on those data in a simple model the costs of a screening program for amblyopia were determined per quality adjusted life year (QALY). The result was analyzed for its stability by sensitivity analysis and compared to the costs of other therapies. Results: Amblyopia occurs with an incidence of approximately 2 % (1.3 - 12 %). Most Screening programs reach a sensitivity of 60 - 90 % and cause costs of 900 - 1400 Euro per detected case. By appropriate therapy with mean costs of 2300 Euro approx. 60 % of the cases obtain useful vision of > 20/40. However, therapy results vary considerably. After discounting the incremental cost-effectiveness ratio (ICER) reaches 7684 Euro/QALY for a screening and treatment program for amblyopia. This is well comparable with other therapies and accepted to be cost-efficient. Sensitivity analysis yielded 24 700 Euro/QALY and 57 633 Euro/QAL with higher discounting for worst case scenarios. Conclusion: Screening for amblyopia meets the basic requirements of cost-effectiveness.

Schlüsselwörter

Gesundheitsökonomie - Epidemiologie - QALY - Amblyopie - Screening

Key words

health economics - epidemiology - QALY - amblyopia - screening

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Dr. med., Dipl. Kfm. Aljoscha S. Neubauer

Augenklinik der Ludwig-Maximilians-Universität

Mathildenstraße 8

80336 München

Phone: ++ 49/89/51 60-38 11

Fax: ++ 49/89/51 60-51 60

Email: Aljoscha.Neubauer@med.uni-muenchen.de

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