Management of ocular hypertension: a cost-effectiveness approach from the Ocular Hypertension Treatment Study.
OBJECTIVE
The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of > or =24 mm Hg reduces the risk of the development of primary open-angle glaucoma (POAG) by 60%. There is no consensus on which people with ocular hypertension would benefit from treatment.


METHODS
Cost-utility analysis with the use of a Markov model.


METHODS
We modeled a hypothetic cohort of people with IOP of > or =24 mm Hg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a > or =5% annual risk of the development of POAG; (3) treat people with a > or =2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated.


RESULTS
The incremental cost-effectiveness ratios for treatment of people with ocular hypertension were 3670 US dollars per quality adjusted life-year (QALY) for the Treat > or =5% threshold and 42,430 US dollars/QALY for the Treat > or =2% threshold. "Treat everyone" cost more and was less effective than other options. Assuming a cost-effectiveness threshold of 50,000 to 100,000 US dollars/QALY, the Treat > or =2% threshold would result in the most net health benefit. The decision was sensitive to the incidence of POAG without treatment, treatment effectiveness, and the utility loss because of POAG.


CONCLUSIONS
Although the treatment of individual patients is largely dependent on their attitude toward the risk of disease progression and blindness, the treatment of those patients with IOP of > or =24 mm Hg and a > or =2% annual risk of the development of glaucoma is likely to be cost-effective. Delay of treatment for all people with ocular hypertension until glaucoma-related symptoms are present appears to be unnecessarily conservative.
Kymes
Steven M
SM
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63110, USA. kymes@vrcc.wustl.edu
Kass
Michael A
MA
Anderson
Douglas R
DR
Miller
J Philip
JP
Gordon
Mae O
MO
D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D005902:Glaucoma, Open-Angle / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D009798:Ocular Hypertension / Q000191:economics* / Q000628:therapy; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States