Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective
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Objective: To assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor. Design: Discrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5)year glaucoma risk is ≥6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive). Setting: UK health services perspective Participants: Simulated cohort (IOP) 24.9mmHg (SD 2.4). Main outcome measures: Costs, glaucoma detected, quality adjusted life years (QALYs). Results: Treating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was most costly and effective. However, considering a wider cost)utility perspective, biennial monitoring was less costly and provided more QALYS than NICE pathways, but was unlikely to be cost)effective compared with treating at diagnosis (£86,717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, NHS service costs and treatment adherence. Conclusions: For confirmed ocular hypertension, glaucoma monitoring more frequently than every two years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness [IOP]) could be considered, however further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended.
Hernández , R , Burr , J M , Vale , L , Azuara-Blanco , A , Cook , J A , Banister , K , Tuulonen , A , Ryan , M & Surveillance of Ocular Hypertension Study group 2016 , ' Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective ' British Journal of Ophthalmology , vol 100 , no. 9 , pp. 1263-1268 . DOI: 10.1136/bjophthalmol-2015-306757
British Journal of Ophthalmology
© 2016, the Author(s). This work is made available online in accordance with the publisher’s policies. This is the author created, accepted version manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at bjo.bmj.com / https://dx.doi.org/10.1136/bjophthalmol-2015-306757
This work was part of the Surveillance for Ocular Hypertension study funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (07/46/02)