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Editors Selection IGR 13-3
Costing Studies: Economic considerations for the diagnosis and management of glaucoma
Comment by George Lambrou on:
28058 Economic considerations of the diagnosis and management for glaucoma in the developed world, Tuulonen A, Current Opinions in Ophthalmology, 2011; 22: 102-109
In a world of increasing healthcare costs, clinical practices will be increasingly dictated by public health policies and therapeutic guidelines. While we all intuitively acknowledge the important of quality Health-Economic evidence in this context, most of us do not have an intimate understanding of what the relevant parameters and metrics are. This probably not unrelated to the fact that ‐ compared to clinical outcome studies ‐ very little is published on glaucoma costs. In that respect, this review paper by Tuulonen (451) fills a common gap for many glaucoma specialists: it is both a short tutorial on Health Economics and a review of published studies on the cost of glaucoma ‐ with an extensive list of relevant references for the interested reader as a bonus.
Although it is not 'easy reading', the paper is worth studying in detail. After an initial explanation of 'what Health Economics is all about', neatly summarized in a table, the author describes her search strategy for relevant publications over the last two years, and how she narrowed her focus from the 72 PubMed hits (a small number in itself) to a mere twenty relevant published papers.
From the analysis of these publications, certain general conclusions can be drawn; mainly that treating established glaucoma is costeffective versus not treating it. However, no such certainty emerges about ocular hypertension, nor about normal-pressure glaucoma. When POAG is treated, the evidence for cost-effectiveness is not congruent among therapies. Similarly, there is limited evidence on cost-effectiveness of systematic screening and case-finding.
All-in-all, as the author concludes, there are limited economic evaluations published to this date and these suggest that we are confused. Further well-designed and pragmatic Health Economics studies are required, to help shape therapeutic guidelines that will ultimately lead to cost-effective interventions in the future.
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