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Abstract #13939 Published in IGR 8-2
Management of ocular hypertension: A cost-effectiveness approach from the Ocular Hypertension Treatment Study
Kymes SM; Kass MA; Anderson DR; Miller JP; Gordon MO; Ocular Hypertension Treatment Study Group (OHTS)American Journal of Ophthalmology 2006; 141: 997-1008
See also comment(s) by Linus Jönsson •
PURPOSE: The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of ≥ 24 mmHg reduces the risk of the development of primary open-angle glaucoma (POAG) by 60%. There is no consensus on which people with ocular hypertension would benefit from treatment. DESIGN: Cost-utility analysis with the use of a Markov model. METHODS: We modeled a hypothetic cohort of people with IOP of ≥ 24 mmHg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a ≥ 5% annual risk of the development of POAG; (3) treat people with a ≥ 2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated. RESULTS: The incremental cost-effectiveness ratios for treatment of people with ocular hypertension were US$3670 per quality adjusted life-year (QALY) for the Treat ≥ 5% threshold and US$42,430/QALY for the Treat ≥ 2% threshold. 'Treat everyone' cost more and was less effective than other options. Assuming a cost-effectiveness threshold of US$50,000 to 100,000/QALY, the Treat ≥ 2% threshold would result in the most net health benefit. The decision was sensitive to the incidence of POAG without treatment, treatment effectiveness, and the utility loss because of POAG. CONCLUSION: Although the treatment of individual patients is largely dependent on their attitude toward the risk of disease progression and blindness, the treatment of those patients with IOP of ≥ 24 mmHg and a ≥ 2% annual risk of the development of glaucoma is likely to be cost-effective. Delay of treatment for all people with ocular hypertension until glaucoma-related symptoms are present appears to be unnecessarily conservative.
Dr. S.M. Kymes, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri; Division of Biostatistics, Washington University School of Medicine, St Louis, MI, USA
Classification:
14 Costing studies; pharmacoeconomics
