The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma.
Summary of "The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma."
Purpose:â€‚ To evaluate the long-term effects and costs of four treatment strategies for primary open-angle glaucoma compared to usual care. Methods:â€‚ Cost-effectiveness analyses with a lifelong horizon were made from a societal perspective. Data were generated with a patient-level model based on discrete event simulation. The model structure and parameter estimates were based on literature, particularly clinical studies on the natural course of glaucoma and the effect of treatment. We simulated heterogeneous cohorts of 3000 patients and explored the impact of uncertainty with sensitivity analyses. Results:â€‚ The incremental cost-effectiveness ratio (ICER) of initial treatment with a prostaglandin analogue compared with a Î²-blocker was â‚¬12.931 per quality-adjusted life year (QALY) gained. A low initial target pressure (15â€ƒmmHg) resulted in 0.115 QALYs gained and â‚¬1550 saved compared to a gradual decrease from 21 to 15â€ƒmmHg upon progression. Visual field (VF) measurements every 6 rather than 12â€ƒmonths lead to health gains at increased costs (ICER â‚¬173â€ƒ486 per QALY gained), whereas measurements every 24â€ƒmonths lead to health losses at reduced costs (ICER â‚¬21â€ƒ516 per QALY lost). All treatment strategies were dominant over 'withholding treatment'. Conclusions:â€‚ From a cost-effectiveness point of view, it seems advantageous to aim for a low intraocular pressure in all glaucoma patients. The feasibility of this strategy should therefore be investigated. Additionally, the cost-effectiveness outcomes of initiating monotherapy with a prostaglandin analogue and reducing the frequency of VF testing may be acceptable.
University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands Department of Health Organisation, Policy, and Econo
This article was published in the following journal.
Name: Acta ophthalmologica
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22289192
- DOI: http://dx.doi.org/10.1111/j.1755-3768.2011.02318.x
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