Health economics analysis of visual acuity and visual field test in Cushing's disease based on risk factors

Abstract

Objective To screen risk factors related to visual acuity and visual field defects in patients with Cushing's disease, and based on risk factors to analyze health economics. Methods A total of 416 patients with Cushing's disease admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from August 1994 to December 2019 were included. Objective examination of visual acuity and visual field was used as the dependent variable, while gender, age, duration, blood glucose, blood pressure, hormone level, eye swelling, imaging features, and main complaint of visual acuity and visual field were used as independent variables. Univariate and multivariate Logistic regression analysis was used to screen the risk factors related to visual acuity and visual field defects, and cost ⁃ effectiveness ratio (CER) and cost ⁃ benefit ratio (CBR) were analyzed based on risk factors. Results Among 416 patients with Cushing's disease, 143 (34.38%) complained of abnormal visual acuity and visual field, including 59 cases of blurred vision, 11 cases of impaired visual field, 41 cases of blurred vision combined with impaired visual field, 13 cases of blurred vision combined with impaired visual field, 3 cases of impaired visual field combined with impaired visual field, and 16 cases of all three symptoms. There were 102 cases (24.52%) with abnormal visual acuity and visual field test, including 44 cases of visual loss, 39 cases of visual field defect, and 19 cases of visual loss combined with visual field defect. Logistic regression analysis showed the increased systolic blood pressure (OR = 1.016, 95%CI: 1.002-1.030; P = 0.025) and abnormal visual acuity and visual field complaints (OR = 14.000, 95%CI: 7.918-24.754; P = 0.000) were risk factors for visual acuity and visual field defects. According to the analysis of health economics, the CER of the whole group was 393 926.53, which was 6.56 times higher than that of the patients with abnormal visual acuity and visual field complaints (60 057.93). The CBR was 4.08, which was 2.25 times higher than that of patients with abnormal visual acuity and visual field complaints (1.81). Conclusions Cushing's disease patients with abnormal visual acuity and visual field complaints are more likely to have abnormal visual acuity and visual field. Therefore, taking abnormal visual acuity and visual field complaints as an indication for visual acuity and visual field test of Cushing's disease patients can improve the detection rate and reduce the waste of health and social resources, which is not only clinically feasible, but also can effectively prevent medical risks.

DOI: 10.3969/j.issn.1672⁃6731.2023.07.009