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Editors Selection IGR 11-3

Health Economics: Health technology assessment of OHT surveillance

Comment by Steve Kymes on:

50515 Surveillance for ocular hypertension: an evidence synthesis and economic evaluation, Burr JM; Botello-Pinzon P; Takwoingi Y et al., Health Technol Assess, 2012; 16: 1-271

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The purpose of a health technology assessment (HTA) is to provide health-policy makers with objective and complete information related to questions concerning programs to promote health or treat disease. In this report, Burr et al. have conducted an exceptionally thorough evaluation of the surveillance of people with ocular hypertension to identify those with glaucoma ‐ examining both clinical and economic aspects of the question. In considering the results of their assessment it is important to contrast the research question being asked here with other evaluations that have been conducted over the past decade. As the authors note in their review of the literature, a number of the clinical studies and economic evaluations have been conducted to address questions concerning diagnosis of or treatment to prevent glaucoma in people with ocular hypertension ‐ most of these were excluded from consideration in this HTA. The difference between evaluation of management of people with ocular hypertension and surveillance of ocular hypertensives may seem a bit obscure (and indeed is not well explained by the authors), but this is the question that the authors have been commissioned to evaluate by the HTA authorities of the United Kingdom.

That caution aside, the evaluation has much to recommend it. The authors have conducted a very thorough review of the clinical and economic literature, including a review of the quality of the various predictive models evaluating the risk of progression to glaucoma among people with ocular hypertension. It is particularly notable that a key element of this evaluation was the assessment of the external validity of published models using data sets from the U.K. and continental Europe. They have also made an effort to incorporate patient preferences for surveillance methods into their evaluation, prospectively collecting preference data from people in the United Kingdom.

The authors [..] recommend screening of stable patients with ocular hypertension no more than once every two years

Consistent with the Preferred Practice Plan of the American Academy of Ophthalmology, the authors in the end recommend screening of stable patients with ocular hypertension no more than once every two years. They also endorse the OHTS-EGPS predictive model as a screening tool. They are less definitive concerning medical treatment of ocular hypertensives to prevent glaucoma ‐ suggesting a threshold of 6-10% (five-year risk of developing glaucoma) under varying conditions. Readers should recognize that the results of the evaluation are difficult to generalize beyond the U.K. because the surveillance options considered are based upon the care-delivery models employed by the U.K. National Health System.

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