| BackgroundMyopia is one of the common and frequently encountered disease in ophthalmology, and it has becomes a increasingly serious public health problem. Our country is a Nearsighted powers. The prevalence of our country is on the rise and it has a younger age trend, for example, in2010, the prevalence of myopia in7-12years old primary school students was40.9%, in13-15years old junior high school students was67.3%, in16-18years old high school students was79.2%and in19-22years old college students was84.7%. Myopia not only comes about serious social and economic burden but also cause some inconveniences of working and studying to the patients. And it also reduces the quality of life to the patients.Cost-utility analysis is one of the important methods in health economics evaluation. The measurement of utility value has been widely used in the field of health. Utility refers to a will or preference social and individual, and this will or preference reflects social or individual some value orientation; Health utility value is in the range of0-1,0means death,1stands for completely health. Internationally, the utility value measurement methods mainly include two types:direct measurement and indirect measurement. The direct measurement includes visual analog scale, time trade-off and standard gamble and the indirect measurement uses multiple attribute scales to measure the utility values.At present, the utility value measurement research in our academia are rare, and the myopia utility value measurement research is still in the blank. Therefore, carrying out the utility value measurement research of myopia patients in our country not only provides reference for clinical doctors and policy makers to provide decision-making basis, but also provides basic data support for the future further cost-utility analysis.ObjectiveThe general objective of this study was to use standard gamble and the time trade-off to measure the utility value of myopia patients in our country in order to understand the myopia patient’s quality of life, to provide reference for the evaluation of health economics research in the future. Specific goals include:1)Using the standard gamble method and the time trade-off to measure utility values of the patients of myopia;2)Comparing the consistency of the two methods;3)Comparing and analyzing the differences and influencing factors of myopia patients using two kinds of method to measure the utility value.MethodsThis study derived from two aspects:One is the collection of existing literature data; The second is the questionnaire survey to the short-sighted in the second affiliated hospital of Shan Dong University of TCM outpatient from March2012to June2013. We interviewed to452myopic patients who were treated trough laster surgery and collect the personal basic information and clinical information. And we use standard gamble and time trade-off to measure the utility values.We adopted the measurement of utility values:the time trade-off methods and standard gamble method which were used widely in the world and improved by Brown and others directed at eye disease. We translated by the national standard procedure of before translation and back translation. We formed the final draft on the basis of seeking for opinions of ophthalmologist and health economists. After obtained informed consent, we completed the survey with the help of the trained senior nurse. The time of investigation was about10minutes.Analysis method mainly includes:1) the descriptive statistics, including mean,95%confidence interval and the median statistical indicators;2) the single factor analysis, including Wilcoxon rank test, Kruskal Wallis test, t test and single factor variance analysis. We used the Bland-Altman Plot method to check the consistency of time trade-off and standard gamble.Results1)The basic information of respondents. We investigated eligible myopia patients in total452people, including10people were excluded in the final analysis results because they could not be completed the questionnaire. The max age is44years old,the smallest is17years old and the average age is23.7±5.3years old in the442respondents; in the occupational structure, students account for nearly half; Nearly three-quarters of respondents are lived in rural areas. The average diopter of the respondents is-4.55±2.09D; The average course of disease of myopia is9.5±5.3years old; Only5%of the respondents don’t wear any pair of glasses.2)The utility values of time trade-off and standard gamble. The mean utility value of myopia patients using time trade-off and standard gamble methods is0.96±0.05(95%CI0.95-0.95, the median is0.96) and0.93±0.09(95%CI0.92-0.92, the median is0.94).the difference measuring the utility value using the two methods is statistically significant (P=0.02).3) The consistency analysis of the two methods measuring utility values. The Bland-Altman Plot method is used to described the ratio the difference of using two methods to measure the utility values (TTO-SG)and the mean using two methods obtained. The results show that the two methods of measuring utility values to patients with myopia is not consistent. 4)The comparison of trading behavior. In the time trade-off method, the overall differences are statistically significant (P<0.001) between the utility value respondents (0.95±0.05) are willing to take the risk of the loss of their lives and the utility value (1.00±0.00) respondents are not willing to take the risk of the loss of their lives. In the standard gamble method, the overall differences are also statistically significant (P<0.001) between the utility value(0.91±0.09) respondents are willing to take the risk of blandness and the utility value (1.00±0.00)respondents are not willing to take the risk of blandness. The trading behavior is statistically significant (P<0.001) in the subgroup of joining the army,entering a higher school and civil service examination. The trading behavior is not statistically significant in other subgroups such as gender, age and occupation and so on.5) The analysis results of influence factors using the two methods to measure utility values. In the time trade-off method, the utility value wearing contact lenses in patients is higher than that wearing glasses(0.97vs0.95, P<0.001). In the standard gamble method, it is not statistical differences in the two groups. In addition, there are not statistically significant in the subgroups such as age, sex, occupation, education level, residence, reason and the severity of myopia.ConclusionsThe utility value is very close using the time trade-off and standard gamble, but there is not consistent in the results using the two methods. The utility value’s differences in the variable are not statistically significant in addition the variables whether the patients wear glasses. The utility values of myopic patients in our study are lower than the utility values of other eye disease in the literature. |
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