Cost-effectiveness of treating ocular hypertension.
OBJECTIVE
To assess the cost-effectiveness of treating ocular hypertension (OHT) in the United States.


METHODS
A Markov model was constructed to perform a cost-effectiveness analysis.


METHODS
Patients with OHT.


METHODS
The health states considered were stable OHT and glaucoma. Practice patterns for the model were derived from the Ocular Hypertension Treatment Study (OHTS), and transition probabilities were derived from previous literature. Specific unit costs used for medications, patient visits, and diagnostic and therapeutic procedures were obtained from Blue Cross/Blue Shield. The time horizon was 5 years. Costs were discounted at 3% per annum.


METHODS
Long-term cost effectiveness of treating OHT to prevent the development of glaucoma.


RESULTS
The incremental cost-effectiveness ratio (ICER) for all OHT patients to prevent 1 case from progressing to primary open-angle glaucoma was $89,072. However, the minimally cost-effective ICER level after adjustment for risk factors identified by multivariate analysis in the OHTS were: 20 years above the average of 56 years, ICER of $45,155; 4 mmHg above the average pressure of 25 mmHg, ICER of $46,748; 40 microm less than the average central corneal thickness of 573 mum, ICER of $36,683; and a vertical cup-to-disc ratio of 0.2 wider than the average of 0.4, ICER of $35,633.


CONCLUSIONS
Based on the results and practice patterns of the OHTS, treating all OHT patients seems not to be cost-effective. However, treating selective OHT patients with risk factors identified in the OHTS, for example, advancing age, higher pressures, thinner central corneal thickness, and wider vertical cup-to-disc ratios, does seem to be cost-effective for preventing the onset of glaucomatous damage.
Stewart
William C
WC
PRN Pharmaceutical Research Network, LLC, Charleston, South Carolina, USA. info@prnorb.com
Stewart
Jeanette A
JA
Nasser
Qasiem J
QJ
Nassar
Qasiem J
QJ
Mychaskiw
Marko A
MA
D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005902:Glaucoma, Open-Angle / Q000517:prevention & control; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007429:Intraocular Pressure; D008390:Markov Chains; D008875:Middle Aged; D009798:Ocular Hypertension / Q000191:economics* / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014130:Trabeculectomy / Q000191:economics; D014481:United States
D000959:Antihypertensive Agents