Resources use, costs and effectiveness of non-penetrating deep sclerectomy according to glaucoma stage

Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Chaoubah, Alfredo

doi:10.1590/s0004-27492011000600003

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…The proportions and frequency of glaucoma medications in operated POAG patients were derived and adapted from the literature. [24] We also included the costs for the inappropriate use of a beta-blocker.…”

Section: Methodsmentioning

confidence: 99%

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

Guedes

Guedes²,

Gomes³

et al. 2016

Medicine

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Background:The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers.Methods:Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year).Results:In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient.Conclusion:All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a preferred strategy for each glaucoma stage, according to a cost-effectiveness ratio ranking.

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Section: Methodsmentioning

confidence: 99%

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

Guedes

Guedes²,

Gomes³

et al. 2016

Medicine

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“…They also showed that the cost increases with advanced glaucoma, thus advocated to perform NPDS in the earlier stage of glaucoma. 98 The results might not be applicable in other settings, since the procedure is surgeon-dependent, with a steep learning curve, 99 and the outcome of NPDS could be variable.…”

Section: Treatment Of Glaucoma Primary Open Angle Glaucomamentioning

confidence: 99%

Cost-effectiveness in the Treatment of Glaucoma

Chan¹,

Li²,

Tham³

2014

US Ophthalmic Review

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The cost-effectiveness of treating different types of glaucoma and ‘pre-glaucoma status’—namely ocular hypertension, primary angle closure suspect, and primary angle closure—were investigated by numerous studies. Overtreatment could lead to undesirable opportunity cost and unnecessary exposure to adverse effects for the patients; under-treating moderate to advance glaucoma could lead to preventable blindness. Despite being a leading cause of blindness, the need for a comprehensive glaucoma screening program and early intervention of pre-glaucoma status is questionable. Numerous reports have investigated the cost-effectiveness of treating ocular hypertension, primary open angle glaucoma, and normal tension glaucoma. The cost-effectiveness of different treatment modalities and their application at different stages of glaucoma were also discussed. To date, there is no cost-effectiveness analysis for the treatment of primary angle closure glaucoma. Some early reports also suggested that prophylactic treatment for primary angle closure and primary angle closure suspect might not be the most effective modalities.

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“…Guedes RAP et al 2011. [15] reported that cost of nonpenetrating deep sclerotomy cost between US $305.25 to US $ 390.09 depending on the severity of glaucoma. Thus, these procedures are as or more cost effective than other options in primary open angle glaucoma seen in the study by Ting NS et al [16] …”

Section: Resultsmentioning

confidence: 99%

Comparative Analysis of Penetrating and Non-Penetrating Glaucoma Surgery in Primary Open Angle Glaucoma

Pendke¹,

Bhalgat²

2016

jemds

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OBJECTIVESPurpose analysis of safety and efficacy of Non-Penetrating Glaucoma Surgery (NPGS) for control and maintenance of intraocular pressure as compared to penetrating glaucoma surgery in Primary Open Angle Glaucoma (POAG) patients. DESIGNA hospital based randomized study. Participants 70, eyes of 70 POAG patients, 35 of which underwent NPGS and the remaining underwent Trabeculectomy surgery. MATERIALSNPGS and trabeculectomy was performed by standard surgical procedures after recording routine preoperative data. Patients were divided into 2 groups depending on the procedure they underwent. All patients were followed up after 1 week, 1 month, 3 months, 6 months and 12 months. Post-operative success was defined as IOP <21 mmHg at 1 month in absence of additional antiglaucoma medication or other treatment. RESULTSA significant reduction in intraocular pressure was observed post-surgery in both groups, changing from a preoperative mean of 31.09±7.37 mmHg and 29.26±7.10 mmHg to a postoperative mean of 15±3.06 mmHg and 14.85±4.22 mmHg respectively (P<0.001) at 12 months for trabeculectomy patients. It was seen that there was approximately constant reduction in all ranges of IOP, while for NPGS patient's best control in IOP was seen between at preoperative IOP between 21 to 30 mmHg. There was a significant difference in complications between two groups and the NPGS group had significantly less number of complications than the trabeculectomy group (p<0.05). However, the trabeculectomy group had a significantly lesser failure rate as compared to the NPGS group (p<0.05). CONCLUSIONTrabeculectomy though more effective for higher preoperative IOP, range is associated with greater risk of complications and hence for IOP range between 21 to 30 mmHg, NPGS would be the surgery of choice due to its equivalent efficacy and much greater safety standards.

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Resources use, costs and effectiveness of non-penetrating deep sclerectomy according to glaucoma stage

Abstract: There is a trend in the use of resources and costs in NPDS. The more advanced the glaucoma, the higher the need for resources and the higher the associated costs. NPDS effectiveness did not differ among different glaucoma stages.

Cited by 5 publications

References 19 publications

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

Cost-effectiveness in the Treatment of Glaucoma

Comparative Analysis of Penetrating and Non-Penetrating Glaucoma Surgery in Primary Open Angle Glaucoma

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