title: Cost-effectiveness of medications compared with laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma.
abstract: OBJECTIVE
  To determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP).
  
  
  METHODS
  Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only.
  
  
  RESULTS
  The incremental cost-effectiveness of LTP over no treatment is $16,824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14,179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value.
  
  
  CONCLUSIONS
  Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105, USA. jdstein@med.umich.edu
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
authors.forename: David D
authors.initials: DD
authors.lastname: Kim
authors.forename: Will W
authors.initials: WW
authors.lastname: Peck
authors.forename: Steven M
authors.initials: SM
authors.lastname: Giannetti
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics*; D003008:Cloprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D003362:Cost-Benefit Analysis; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D006304:Health Status; D006801:Humans; D053685:Laser Therapy / Q000191:economics*; D008390:Markov Chains; D055118:Medication Adherence; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014130:Trabeculectomy / Q000191:economics*; D000069557:Travoprost
chemical_list: D000959:Antihypertensive Agents; D003008:Cloprostenol; D000069557:Travoprost