Modelling the lifetime economic consequences of glaucoma in France.
OBJECTIVE
To estimate the lifetime economic consequences of glaucoma in France.


METHODS
A Markov model estimated the average discounted outcome and cost of glaucoma treatment over a patient's lifetime. Clinical states were defined as first- to fourth-line drugs, no treatment, laser therapy, surgery, blindness and death. After each failure (always after the fourth-line drug) patients could receive either laser treatment or surgery followed by no treatment, or a new treatment. A societal perspective was adopted. Sensitivity analyses were performed.


RESULTS
Discounted medical costs were euro 7,322 for ocular hypertension treatment (OHT) and euro 8,488 for a glaucoma patient. Social costs of OHT and glaucoma patients exceeded medical costs. First-line use of the most effective drug would reduce medical and social costs. Societal willingness to pay for the vision benefit would equal the medical costs. Treatment initiated with the most effective drug is a cost saving strategy.


CONCLUSIONS
Public health decisions in glaucoma treatment should take a broad economic view embracing the lifetime duration of the disease. There is still a place both within and outside the healthcare system for therapeutic innovations with important economic consequences that bring high added value to patients.
Philippe Nordmann
Jean
J
Hôpital des Quinze-Vingts, Centre Hospitalier National d'Ophtalmologie, Paris, France.
Lafuma
Antoine
A
Berdeaux
Gilles
G
D001766:Blindness / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D003661:Decision Support Techniques; D018450:Disease Progression; D005602:France; D005901:Glaucoma / Q000150:complications / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years