title: The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma.
abstract: OBJECTIVE
  To evaluate the long-term effects and costs of four treatment strategies for primary open-angle glaucoma compared to usual care.
  
  
  METHODS
  Cost-effectiveness analyses with a lifelong horizon were made from a societal perspective. Data were generated with a patient-level model based on discrete event simulation. The model structure and parameter estimates were based on literature, particularly clinical studies on the natural course of glaucoma and the effect of treatment. We simulated heterogeneous cohorts of 3000 patients and explored the impact of uncertainty with sensitivity analyses.
  
  
  RESULTS
  The incremental cost-effectiveness ratio (ICER) of initial treatment with a prostaglandin analogue compared with a β-blocker was €12.931 per quality-adjusted life year (QALY) gained. A low initial target pressure (15 mmHg) resulted in 0.115 QALYs gained and €1550 saved compared to a gradual decrease from 21 to 15 mmHg upon progression. Visual field (VF) measurements every 6 rather than 12 months lead to health gains at increased costs (ICER €173,486 per QALY gained), whereas measurements every 24 months lead to health losses at reduced costs (ICER €21,516 per QALY lost). All treatment strategies were dominant over 'withholding treatment'.
  
  
  CONCLUSIONS
  From a cost-effectiveness point of view, it seems advantageous to aim for a low intraocular pressure in all glaucoma patients. The feasibility of this strategy should therefore be investigated. Additionally, the cost-effectiveness outcomes of initiating monotherapy with a prostaglandin analogue and reducing the frequency of VF testing may be acceptable.
authors.affiliation: University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Aukje
authors.initials: A
authors.lastname: van Gestel
authors.forename: Carroll A
authors.initials: CA
authors.lastname: Webers
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Henny J
authors.initials: HJ
authors.lastname: Beckers
authors.forename: Nomdo M
authors.initials: NM
authors.lastname: Jansonius
authors.forename: Fred
authors.initials: F
authors.lastname: Hendrikse
authors.forename: Jan S
authors.initials: JS
authors.lastname: Schouten
mesh_terms: D000287:Administration, Topical; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000068438:Brimonidine Tartrate; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D009883:Ophthalmic Solutions; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D019057:Quality-Adjusted Life Years; D011810:Quinoxalines / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D013999:Timolol / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions; D011461:Prostaglandins F, Synthetic; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; D000068438:Brimonidine Tartrate; D000077338:Latanoprost; D013999:Timolol; C062765:dorzolamide