title: Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS).
abstract: OBJECTIVE
  Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up.
  
  
  METHODS
  A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated.
  
  
  RESULTS
  Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant.
  
  
  CONCLUSIONS
  Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).
authors.affiliation: Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil. palettaguedes@yahoo.com
authors.forename: Ricardo Augusto Paletta
authors.initials: RA
authors.lastname: Guedes
authors.forename: Vanessa Maria Paletta
authors.initials: VM
authors.lastname: Guedes
authors.forename: Alfredo
authors.initials: A
authors.lastname: Chaoubah
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D001938:Brazil; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000191:economics* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D011465:Prostaglandins, Synthetic / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D012599:Sclerostomy / Q000191:economics* / Q000379:methods; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D013999:Timolol / Q000191:economics / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D011465:Prostaglandins, Synthetic; D013449:Sulfonamides; D013876:Thiophenes; D013999:Timolol; C062765:dorzolamide