title: The long term effectiveness and cost-effectiveness of initiating treatment for ocular hypertension.
abstract: OBJECTIVE
  To investigate the long-term health and economic consequences of direct treatment initiation in ocular hypertension patients.
  
  
  METHODS
  A cost-effectiveness analysis with a societal perspective and a lifelong horizon was performed. The primary outcomes were the incremental quality-adjusted life years (QALYs) and costs of direct pressure-lowering treatment for ocular hypertension, compared to a strategy where treatment is postponed until conversion to glaucoma has been observed. We used a decision analytic model based on individual patient simulation to forecast disease progression and treatment decisions in both strategies in a representative heterogeneous patient population and in 18 patient subgroups stratified by initial intraocular pressure and additional risk factors for conversion.
  
  
  RESULTS
  The incremental discounted health gain of direct treatment was 0.27 QALYs, whereas the incremental discounted costs were -€ 649 during an average lifetime of 26 years. In the simulations of patient subgroups, the model outcomes moved towards higher health gains and lower incremental costs with increasing risk of conversion in the patient population. The incremental cost-effectiveness ratio of direct treatment ranged from € 15,425 per QALY gained in the lowest-risk subgroup to dominance in the highest-risk subgroup. Probabilistic sensitivity analysis indicated that uncertainty surrounding the model input parameters did not affect the conclusions.
  
  
  CONCLUSIONS
  Direct, early, pressure-lowering treatment is a dominant cost-effective treatment strategy over a strategy to start the same treatment approach later, after glaucoma has occurred for patients with ocular hypertension. Its implementation and consequences should be discussed with ophthalmologists and individual patients.
authors: University Eye Clinic Maastricht, University Medical Center, Maastricht, the Netherlands.
authors: Aukje
authors: A
authors: van Gestel
authors: Jan S A G
authors: JS
authors: Schouten
authors: Henny J M
authors: HJ
authors: Beckers
authors: Johan L
authors: JL
authors: Severens
authors: Fred
authors: F
authors: Hendrikse
authors: Carroll A B
authors: CA
authors: Webers
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D018463:Filtering Surgery; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D016544:Patient Simulation; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014065:Tonometry, Ocular; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: cost-effectiveness; long-term outcomes; ocular hypertension; treatment