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

Abstract

Objective To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon. Setting: 22 hospital eye services in the United Kingdom. Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC). Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery). Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care. Results: The mean age of participants was 67.5 (8.42), 57.5% were female, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67-89% chance of being cost effective at 3 years, and that it may be cost saving by 10 years.