Zusammenfassung
Hintergrund
Die „value-based medicine“ (VBM) nimmt eine Bewertung der Aufwendungen (Kosten) für medizinisches Handeln mit dem resultierenden Nutzen für den Patienten vor. Das ermöglicht eine quantitative Analyse von Diagnostik- und Therapieoptionen mit zunehmender Bedeutung auch in der Augenheilkunde.
Methoden
Anhand relevanter Publikationen wird das gesundheitsökonomische Vorgehen der VBM erläutert, und es werden die hierbei verwendeten Methoden und Begriffe erklärt.
Ergebnisse
Die VBM umfasst über die „evidence-based medicine“ hinaus die Parameter Kosten für die ophthalmologischen Aufwendungen und Lebensqualität. Die visuelle Funktion wird durch das Time-trade-off-Verfahren als Nutzwert („utility“) abgebildet. Ophthalmologische Interventionen führen zu Nutzwertgewinn oder Nutzwerterhalt. Bei der Kosten-Nutzwert-Analyse werden aus Nutzwertgewinn und Lebenszeit qualitätsbereinigte Lebensjahre (QALYs) berechnet und in Verhältnis zu den Kosten gesetzt (€/QALY). Einige Kosten-Nutzwert-Analysen bei augenärztlichen Interventionen wurden bereits erstellt.
Schlussfolgerungen
Das wesentliche Instrument der VBM ist die Kosten-Nutzwert-Analyse. Die Ergebnisse in Kosten/QALY erlauben eine Einschätzung zur Kosteneffektivität ärztlicher Handlungen in der Augenheilkunde. Durch die Anwendung des Time-trade-off-Verfahrens ist eine fachübergreifende Beurteilung möglich, aber auch für individuelle Entscheidungen sind die Ergebnisse aus Berechnungen der VBM von Bedeutung.
Abstract
Purpose
Value-based medicine (VBM) unifies costs and patient-perceived value (improvement in quality of life, length of life, or both) of an intervention. Value-based ophthalmology is of increasing importance for decisions in eye care.
Methods
The methods of VBM are explained and definitions for a specific terminology in this field are given. The cost-utility analysis as part of health care economic analyses is explained.
Results
VBM exceeds evidence-based medicine by incorporating parameters of cost and benefits from an ophthalmological intervention. The benefit of the intervention is defined as an increase or maintenance of visual quality of life and can be determined by utility analysis. The time trade-off method is valid and reliable for utility analysis. The resources expended for the value gained in VBM are measured with cost-utility analysis in terms of cost per quality-adjusted life years gained (euros/QALY). Numerous cost-utility analyses of different ophthalmological interventions have been published.
Conclusion
The fundamental instrument of VBM is cost-utility analysis. The results in cost per QALY allow estimation of cost effectiveness of an ophthalmological intervention. Using the time trade-off method for utility analysis allows the comparison of ophthalmological cost-utility analyses with those of other medical interventions. VBM is important for individual medical decision making and for general health care.
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Hirneiß, C., Neubauer, A.S., Tribus, C. et al. „Value-based medicine“ in der Augenheilkunde. Ophthalmologe 103, 493–500 (2006). https://doi.org/10.1007/s00347-006-1340-9
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DOI: https://doi.org/10.1007/s00347-006-1340-9