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Editors Selection IGR 17-4

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Comment by Jeffrey Liebmann on:

49037 Cost-effectiveness of Medications Compared With Laser Trabeculoplasty in Patients With Newly Diagnosed Open-Angle Glaucoma, Stein JD; Kim DD; Peck WW et al., Archives of Ophthalmology, 2012; 130: 497-505

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Economic modeling for the delivery of cost-effective and efficient health care is becoming an important tool for the development of health care policy and has implications for the care of glaucoma in both developed and developing countries.

In this study, Stein and colleagues compared three treatment paradigms for early open-angle glaucoma in the United States: observation alone, treatment with a prostaglandin analogue, and initial laser trabeculoplasty. They used the highest quality evidence available to them, such as the results of the Glaucoma Laser Trial (GLT),² which compared initial laser surgery to topical medicines and the published efficacy of prostaglandin analogues. To build their model, they assumed an age of glaucoma onset of 60 years, a 25-year life expectancy, rates of disease progression at various stages of glaucoma severity, estimates of the cost of vision-related disability, and used a Markov data analysis model to quantify costs over time as the disease progresses.

After taking into the cost of medicines and assuming that prostaglandin analogues are approximately 30% more effective than the medication used in the GLT, the authors found that initial treatment with a PGA to be more cost-effective, as measured by quality-adjusted life years, than initial laser trabeculoplasty. Both treatment options were considerably more cost-effective than observation alone. The authors recognized that if patients are non-compliant with the medication more than 25% of the time, or the assumptions about the IOP-lowering effect of each treatment are different, then laser trabeculoplasty could become the more cost-effective treatment.

Both laser trabeculoplasty and treatment with a prostaglandin analogue are reasonable initial treatments for early open-angle glaucoma

In summary, both laser trabeculoplasty and treatment with a prostaglandin analogue are reasonable initial treatments for early open-angle glaucoma. Each treating physician needs to determine the preferred patient treatment based upon his/her population, national and local resources, drug availability and cost, and the desire and goals of the individuals being treated.

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