The treatment of primary open-angle glaucoma is cost effectiveeven when its effects are limited, reports a study in Mays Ophthalmology. If the patient responds well to treatment, or if regular assessments are excluded from the calculation, glaucoma treatment becomes even more effective in this cost-per-quality adjusted life year (QALY) analysis.

Researchers created a computer simulation of 20 million patients who were followed from age 50 until either death or age 100. They monitored the incidence, diagnosis and progression in these patients. The researchers also simulated either conservative or optimistic treatment efficacy; conservative results were based on those in the Early Manifest Glaucoma Trial (EMGT), in which risk of progression was 0.60. Optimistic results were based on findings of the Collaborative Initial Glaucoma Treatment Study, which demonstrated progression risks of 0.022 with prescription drug-based control of IOP and 0.029 with surgical control of IOP.

Results were measured in the patients willingness to pay for treatment as affected by quality-adjusted life years. Versus no treatment, the researchers found that routine care cost $46,000 per QALY when the outcome is moderate. When the outcome is better, the cost of routine care per QALY drops to $28,000. Assuming conservative efficacy, treatment was cost effective 100% of the time once the patients willingness to pay reached a threshold of $28,000 per QALY gained.

This study did not accommodate all variables, noted the researchers; for example, treatment costs were assumed equal for both conservative and optimistic outcomes. Also, all costs were not factored into the equation, only those from the health care perspective (i.e., lost productivity due to vision loss or informal care costs were not calculated).

But, researchers note, these findings economically support the need for routine diagnosis and treatment of primary open-angle glaucoma through a demonstration of the amount of quality-adjusted life years possible for patients with therapy and management. They also suggest that additional studies could clarify the cost-effectiveness of diagnostic assessments when including more than one condition.

Rein DB, Wittenborn BS, Lee PP, et al. The cost-effectiveness of routine office-based idnentification and subsequent medical treatment of primary open-angle glaucoma in the United States. Ophthalmology 2009 May;119(5):823-32.

Vol. No: 146:06Issue: 6/15/2009