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Editors Selection IGR 12-4
Health Economics: Cost analysis of treating PACG by early lens extraction
Comment by Anja Tuulonen on:
71288 Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial, Javanbakht M; Azuara-Blanco A; Burr JM et al., BMJ open, 2017; 7: e013254
The landmark EAGLE study represents the first pragmatic glaucoma cost-effectiveness analysis based on three-year trial data. As the effects of treatment are expected to persist further into the future, in addition a Markov model was developed to extrapolate the results up to ten years (assumptions of some input parameters derived also the from literature).
Lens extraction was estimated 67-89% on being cost-effective at three years
The data set consisted of 285 patients with primary angle closure glaucoma in 22 UK centers. Using web-based randomization, 145 eyes received early lens extraction and 140 laser peripheral iridotomy. Effectiveness was measured in terms of quality-adjusted life years (QALY) gained by completing EQ-5D questionnaire at baseline, six, 12, 24 and 36 months. Glaucoma Utility Index was administered as disease-specific instrument. All cost elements were summed to generate a total cost per patient for 2012-2013 (UK perspective). The primary economic outcome was the incremental cost per QALY gained (Incremental Cost-Effectiveness Ratio, ICER).
The incremental cost for lens extraction was £ 981 for QALY gain of 0.069, yielding an ICER of £ 14 282 per QALY. Lens extraction was estimated 67-89% on being cost-effective at three years with ceiling willingness-to pay at £ 20 000.
The model based on extrapolation suggested that lens extraction may become a costsaving strategy over ten-year horizon. Although the complete utility and cost data were not available in 37% of patients and the mean cost and utility values were assumed to be constant beyond three years, the deterministic sensitivity analysis showed that modelbased findings were generally robust. Pragmatic randomized study design with adequate randomization, intention-to-treat analysis and collection trial based data for economic analysis are strengths of the study. The EAGLE study encourages to design further pragmatic cost-effectiveness studies in order to confirm that every-day glaucoma care improves patients' well-being and is worth the money spent, both in diagnostics and treatment.
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