Treating patients for POAG has ‘best net health results,’ study shows

Treating patients who have an IOP of at least 24 mm Hg may be a cost-effective way to manage ocular hypertension, a cost-analysis model shows. The study also indicated a cost savings in treating patients who have at least a 2% annual risk for developing primary open angle glaucoma, according to the model.

Steven M. Kymes, PhD, colleagues in the Ocular Hypertension Treatment Study Group reported the results of a hypothetical economic evaluation. Their study, which involved a cohort of patients with IOP of at least 24 mm Hg, examined the cost-effectiveness of treating ocular hypertension based on a patient's risk of developing POAG.

The investigators evaluated four treatment thresholds: treat no one, treat patients with a 5% or greater annual risk, treat patients with a 2% or greater annual risk and treat everyone. They then evaluated the cost-effectiveness ratio for each considering the cost of treatment, the cost of avoiding the progression of visual loss and the effect on quality of life.

Dr. Kymes and colleagues reported that treating the patients with at least a 5% annual risk of developing POAG had an incremental cost effectiveness ratio of $3,670 per quality adjusted life year, and $42,430 per quality adjusted life year for those with at least a 2% annual risk. The “treat everyone” threshold was more expensive and less effective, according to the researchers.

In the study, the researchers concluded that the “treat at least a 2%” threshold would have the best net health results, “assuming a cost-effectiveness threshold of $50,000 to $100,000 per quality adjusted life year,” they said.

Dr. Kymes and colleagues also noted that delaying treatment of ocular hypertension until there is evidence of glaucoma-related visual field loss is an “unnecessarily conservative” approach.

The study appeared in the June issue of the American Journal of Ophthalmology.