Is primary trabeculectomy cost-effective for patients with advanced primary open angle glaucoma? Results from the Treatment of Advanced Glaucoma Study economic model
Abstract
Background/aims Advanced primary open angle glaucoma (POAG) is a lifelong condition. The aim of this study is to compare medical treatment against trabeculectomy for patients presenting with advanced POAG using an economic evaluation decision model. Methods A Markov model was used to compare the two treatments, medical treatment versus trabeculectomy for the management of advanced POAG, in terms of costs and quality-adjusted life-years (QALYs). The uncertainty surrounding the model findings was assessed using probabilistic sensitivity analysis and deterministic analysis. Data for the model came from Treatment of Advanced Glaucoma Study supplemented with data from the literature. The main outcomes of the model presented in terms of Incremental costs and QALYs based on responses to the EQ-5D-5L, Health Utilities Index-3 and a Glaucoma Utility Index. Results In the base-case analysis (lifetime horizon and EQ-5D-5L measure), participants receiving trabeculectomy had on average, an additional cost of £2687, an additional 0.28 QALYs and an incremental cost per QALY of £9679 compared with medical treatment. There was a 73% likelihood of trabeculectomy being considered cost-effective when society was willing to pay £20 000 for a QALY. Over shorter time horizons, the incremental cost per QALY gained from trabeculectomy compared with medical treatment was higher (47 663) for a 2-year time horizon. Our results are robust to changes in the key assumptions and input parameters values. Conclusion In patients presenting with advanced POAG, trabeculectomy has a higher probability of being cost-effective over a patient’s lifetime compared with medical treatment.
Citation
Shabaninejad , H , Homer , T , Kernohan , A , King , A J , Burr , J , Azuara-Blanco , A & Vale , L 2024 , ' Is primary trabeculectomy cost-effective for patients with advanced primary open angle glaucoma? Results from the Treatment of Advanced Glaucoma Study economic model ' , British Journal of Ophthalmology , vol. Online First , 323390 . https://doi.org/10.1136/bjo-2023-323390
Publication
British Journal of Ophthalmology
Status
Peer reviewed
ISSN
0007-1161Type
Journal article
Description
This work was supported by the National Institute for Health Research Health Technology Assessment Programme, grant number (12/35/38).Collections
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