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14-02-2012 | General practice | Article

Medication, laser trabeculoplasty ‘equally cost-effective’ for open-angle glaucoma


Free abstract

MedWire News: Treatment with both generic topical prostaglandin analogs (PGAs) or laser trabeculoplasty (LTP) are cost-effective options for the management of newly diagnosed mild open-angle glaucoma, report researchers.

"Assuming optimal medication adherence, generic PGAs confer greater value compared with LTP," write Joshua Stein (University of Michigan, Ann Arbor, USA) and co-authors. "However, when assuming more realistic levels of medication adherence, at current prices for PGAs, LTP may be a more cost-effective alternative."

They explain that open-angle glaucoma is one of the leading causes of irreversible vision loss in the USA, affecting more than three million individuals. Several treatment options have been proposed, but their cost-effectiveness has not been investigated.

The researchers therefore used a Markov model with a 25-year horizon to compare the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only (control).

As reported in the Archives of Ophthalmology, the expected cost of untreated glaucoma for a single patient is US$ 2700 (€ 2050). The long-term cost of undergoing LTP is $ 13,788 (€ 10,467) and the cost of receiving PGAs is $ 18,101 (€ 13,743).

Compared with an untreated patient, a patient who received LTP had 0.65 more quality-adjusted life years (QALYs), and one who received PGAs had 1.09 more QALYs, during the 25 years.

The incremental cost-effectiveness of LTP over no treatment is $ 16,824 (€ 12,773) per QALY, report Stein et al. However, the incremental cost-effectiveness of PGAs over no treatment was $ 14,179 (€ 10,769) per QALY, and PGAs "provide greater health-related quality of life relative to LTP," they say.

However, if PGAs are 25% less effective because of poor patient medication adherence, LTP can confer greater value, they suggest.

Therefore, "our findings highlight the importance of medication adherence in determining which intervention is most cost-effective," concludes the team.

They add: "Identifying strategies to improve medication adherence will not only improve patient outcomes but also improve the cost-effectiveness of treating glaucoma with PGAs or other medications.

"Furthermore, if researchers can develop novel means of administering glaucoma medications (eg, intraocular injections) that reduce the need for adherence, assuming these medications are not overly costly, this too can improve the cost-effectiveness of caring for patients with open-angle glaucoma."

By Nikki Withers

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