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Editors Selection IGR 20-1

Pharmacoeconomics: Costs of early vs. Late laser and surgery

Comment by Gauti Johannesson on:

79286 A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery, Zhao PY; Rahmathullah R; Stagg BC et al., JAMA ophthalmology, 2018; 136: 1271-1279

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The global prevalence of glaucoma is expected to increase substantially in the future and will possibly affect over 110 million people worldwide by 2040, with most glaucoma patients residing in developing countries.¹ Thus, the cost of glaucoma treatment becomes increasingly important in relationship to the household income in these countries.

This study highlights this important relationship by investigating the cost of glaucoma medications, laser trabeculoplasty (LTP) and trabeculectomy in 38 countries worldwide relative to median annual household income (MA-HHI). The included countries represent almost two thirds of the global population and include both developed and developing countries.

The authors found an extensive difference between countries where costs of topical treatment, LTP and trabeculectomy were ≥ 2.5% of MA-HHI in 41%-78% of developed countries, but 65%-95% in developing countries. Of the treatments investigated, timolol seemed to be a viable option for glaucoma patients all over the world. However, the authors also highlight that although costly initially, surgery may be a good option for glaucoma patients in developing countries due to the high long-term cost of medications. Comparing costs of glaucoma treatments between countries is an important task, but there are several limitations and confounding factors that need to be considered. These include the existence of national health care insurance in some countries, difficulties in obtaining reliable information on costs, surgery related costs and patients adherence. This is the first study to compare costs of glaucoma treatment in a global perspective. Overall, it shows that the cost of glaucoma treatment represents too large a proportion of median annual household income for patients in many countries. The results emphasize that, in order to successfully decrease visual disability due to glaucoma worldwide, treatment options in glaucoma need to become more affordable.

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