Cost-Effectiveness of Options to Treat Open-Angle Glaucoma



A minimally invasive procedure called laser trabeculoplasty (LTP) and glaucoma medication known as prostaglandin analogs (PGAs) both appear to be cost-effective options for patients with newly diagnosed mild open-angle glaucoma, but LTP may be more cost effective if medication adherence is not optimal and considering current prices for PGAs, according to a study based on a computerized mathematical model and published Online First by Archives of Ophthalmology, one of the JAMA/Archives journals.

However, assuming optimal medication adherence, generic PGAs confer greater value compared with LTP, the authors conclude.

Open-angle glaucoma (OAG) is one of the leading causes of irreversible vision loss in the U.S., affecting more than 3 million people. Previous clinical trials have shown that decreasing intraocular pressure (IOP) can reduce the risk of developing OAG among patients with ocular hypertension and can reduce the risk for disease progression in patients with glaucoma, the authors write in study background. Topical glaucoma medications, LTP and incisional glaucoma surgery are ways to reduce IOP.

Joshua D. Stein, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues used a mathematical method and performed a cost-effectiveness analysis of treating patients diagnosed mild open-angle glaucoma with PGAs, LTP or observation only.

“The incremental cost-effectiveness of LTP over no treatment was $16,824 per QALY [quality-adjusted life year]. However, the incremental cost-effectiveness of PGAs over no treatment was $14,179 per QALY, and PGAs provide greater health-related quality of life relative to LTP,” their results suggest.

But if PGAs are 25 percent less effective because of poor patient medication adherence, LTP could be the preferred option, they suggest.

“Our findings highlight the importance of medication adherence in determining which intervention is most cost-effective,” the authors conclude.

(Arch Ophthalmol. doi:10.1001/archopthalmol.2011.2727.