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Cost-effectiveness dependent on glaucoma diagnostic costs, treatment efficacy
Ophthalmology. 2009;116(5):823-832.
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Routine glaucoma treatment proved cost-effective when diagnostic assessment costs were omitted and optimistic treatment efficacy was assumed, a study showed.
The inclusion of diagnostic testing costs and conservative treatment efficacy also denoted reasonable cost-effectiveness, the study authors said.
"Glaucoma treatment was highly cost-effective when the costs of diagnostic assessments were excluded or when we assumed optimistic treatment efficacy," they said.
The study involved a computer simulation of 20 million patients followed from age 50 years. Primary outcome measures were visual field loss, costs of ophthalmic and nursing home care, quality-adjusted life years (QALYs), cost per QALY gained and costs per year of sight gained. Costs and QALYs were adjusted to 2005 equivalent values.
Results showed that, when diagnostic costs were included, the incremental cost-effectiveness of routine glaucoma assessment and treatment was $46,000 per QALY gained, assuming conservative treatment efficacy, and $28,000 per QALY gained, assuming optimistic efficacy.
When diagnostic costs were excluded, the incremental cost-effectiveness of routine assessment and treatment was $20,000 per QALY gained, assuming conservative efficacy, and $11,000 per QALY gained, assuming optimistic efficacy.
"The cost-effectiveness was most sensitive to the treatment costs and the value of QALY losses assigned to visual field losses," the authors said.
Rein and colleagues have reminded us that cost-effectiveness studies are not always used to restrict access to the health system, but can also be used to value enhanced access. Using state-of- the-art methods, the authors have demonstrated somewhat definitively that the effectiveness of treatment of early glaucoma shown in the EMGT and CIGTS studies is such that it is cost-effective for vision care providers to routinely conduct examination of the ocular nerve head to identify evidence of glaucomatous nerve damage. While this evidence is not strong enough to argue for the reconsideration of the recommendation of the U.S. Preventive Health Services Task Force against population-based glaucoma screening, it does clearly show that office-based screening is likely to be cost-effective. At the same time, we must caution policymakers that this work does not incorporate the findings of the OHTS team, which showed that treatment of people with ocular hypertension at moderate to high risk of progression to glaucoma was cost-effective. Reconciliation of these two findings remains a task for further consideration.
– Steven M. Kymes, PhD
Research Assistant
Professor in Ophthalmology and Visual Sciences, Senior Research Fellow, Center
for Health Policy, Washington University School of Medicine