The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open-angle glaucoma in the United States.
OBJECTIVE
To estimate the incremental cost-effectiveness of routine glaucoma assessment and treatment under current eye care visit and treatment patterns and different levels of treatment effectiveness (from randomized trials).


METHODS
We compared the costs and benefits of routine glaucoma assessment and treatment compared with no treatment using conservative and optimistic assumptions regarding treatment efficacy and including and excluding prediagnostic assessment costs.


METHODS
Computer simulation of 20 million people followed from age 50 years to death or age 100 years.


METHODS
With the use of a computer model, we simulated glaucoma incidence, natural progression, diagnosis, and treatment. We defined glaucoma incidence conservatively as a mean deviation of -4 decibels (dB) on visual field testing in either eye for all diagnoses to be both clinically meaningful and unambiguous. We simulated the annual probability of subsequent progression and the quantity of visual field lost when progression occurred.


METHODS
Visual field loss, ophthalmologic and nursing home costs, quality-adjusted life years (QALYs), cost per QALY gained, and cost per year of sight gained. Costs and QALYs were discounted to 2005 values using a 3% rate.


RESULTS
Compared with no treatment and when including diagnostic assessment costs, the incremental cost-effectiveness of routine assessment and treatment was $46,000 per QALY gained, assuming conservative treatment efficacy, and $28,000 per QALY gained, assuming optimistic treatment efficacy. Compared with 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. The cost-effectiveness was most sensitive to the treatment costs and the value of QALY losses assigned to visual field losses.


CONCLUSIONS
Glaucoma treatment was highly cost-effective when the costs of diagnostic assessments were excluded or when we assumed optimistic treatment efficacy. The cost was reasonable and in line with other health interventions even when diagnostic assessment costs were included and assuming conservative efficacy.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Rein
David B
DB
RTI International, Research Triangle Park, North Carolina. drein@rti.org
Wittenborn
John S
JS
Lee
Paul P
PP
Wirth
Kathleen E
KE
Sorensen
Stephen W
SW
Hoerger
Thomas J
TJ
Saaddine
Jinan B
JB
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics*; D004185:Disability Evaluation; D018450:Disease Progression; D018463:Filtering Surgery / Q000191:economics*; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D008954:Models, Biological; D009735:Nursing Homes / Q000191:economics; D010824:Physicians' Offices; D019057:Quality-Adjusted Life Years; D014481:United States; D014786:Vision Disorders / Q000175:diagnosis / Q000517:prevention & control*; D014794:Visual Fields
D000959:Antihypertensive Agents