The Cost-Effectiveness of Routine Identification and Subsequent Medical Treatment of Primary Open-Angle Glaucoma in the United States
This study estimated the incremental cost-effectiveness of routine glaucoma assessment and treatment under current eye care visit and treatment patterns and different levels of treatment effectiveness. The study found that glaucoma treatment was highly cost-effective when the costs of diagnostic assessments were excluded and were reasonable and in line with other health interventions even when diagnostic assessment costs were included and assuming conservative efficacy. Compared to no treatment and when including diagnostic assessment costs, the incremental cost-effectiveness of routine assessment and treatment was $46,000 per quality adjusted life (QALY) gained assuming conservative treatment efficacy and $28,000 per QALY gained assuming optimistic treatment efficacy. Compared to no treatment and when excluding diagnostic assessment costs, the incremental cost-effectiveness of routine assessment and treatment was $20,000 per QALY gained assuming conservative treatment efficacy and $11,000 per QALY gained assuming optimistic treatment efficacy.
Incremental Cost-Effectiveness of Routine Assessment and Treatment Compared to no Care
| Cost Per Simulated Agent* | Outcomes Per Simulated Agent* | Incremental Cost-Effectiveness Ratios‡ | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Full Ophthalmologic Costs | Nursing Home Costs | Total Costs | Total Costs minus Assessment Cost | Years Without Visual Impairment and Blindness†| Quality-Adjusted Life Years (QALYs) | Total Cost Per Year of Normal Sight Gained | Total Cost Per QALY Gained | Total Cost minus Assessment Cost Per QALY Gained | |
| No treatment | $0 |
$104 | $104 | $104 | 17.721 | 15.499 | NA | NA | |
| Routine diagnosis and subsequent treatment, EMGT efficacy | $417 | $78 |
$495 |
$274 |
17.742 |
15.508 | |||
| Incremental (compared with no treatment) | $417 | ($26) | $391 | $170 | 0.021 | 0.009 | $19,000 | $46,000 | $20,000 |
| Routine diagnosis and subsequent treatment, CIGTS efficacy | $415 | $60 | $475 | $253 | 17.767 | 15.512 | |||
| Incremental (compared with no treatment) | $415 | ($44) | $371 | $149 | 0.045 | 0.013 | $8,000 | $28,000 | $11,000 |
Rein DB, Wittenborn JS, Lee PP, Wirth KE, Sorensen SW, Hoerger TJ, Saaddine SB. The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open—angle glaucoma in the United States. Ophthalmology 2009;116:5;pages 823–832.
