Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

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

doi:10.1590/s0004-27492012000100002

Cited by 10 publications

(7 citation statements)

References 19 publications

(15 reference statements)

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“…Similar to our study is that of Guedes et al, which used a decision analysis model for a 5-year time horizon from the point of view of the Brazilian Public National Health System (49). The study evaluated treatments post application of topical medication and found that non-penetrating deep sclerectomy (NPDS) is less costly and more effective than medical therapy when three topical medications are required (50). The fact that the cost increases with advanced glaucoma, this suggests that therapy is necessary in the earlier stage of glaucoma (47).…”

Section: Discussionsupporting

confidence: 56%

Modeling the Pharmacotherapy Cost and Outcomes of Primary Open-Angle Glaucoma With Dry Eye

Tachkov

Vassilev

Kostova

2019

Front. Public Health

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We aimed to analyze and model the cost and results of current outpatient pharmacotherapy practice in patients with primary open-angle glaucoma concomitant with dry-eye disease (POAG+DE). The point of view is that of the health care system and patients, and the time horizon was 1 year. Data were collected through a prospective, observational, real-life study of therapy practice in patients admitted to the specialized ophthalmology clinic at the Alexandrovska University Hospital in Sofia. Pharmacotherapy was recorded and analyzed by therapeutic group and INN. The probability of being prescribed preservative-free or non-free formulations was calculated, as were the cost of yearly therapy, reimbursed cost, and patient co-payment. A decision tree exploring the cost-effectiveness of preservative-free and preservative non-free formulations was built. Outcomes were recorded through three tests measuring tear film stability: TMS, NIBUT Ave, and ST. TMS values below 3, ST above 10 mm, and NIBUT Ave above 14 s were considered as indicators of good disease control. A total of 140 eyes were diagnosed with POAG, of which 64 had concomitant dry-eye disease and were included in the analysis. Monotherapy was prescribed to 34: 14 on preservative-free formulations and 20 on nonfree. Meanwhile, 30 eyes received combination therapy: six on preservative-free and 24 on non-free. The monotherapy product was most commonly Prostaglandin Analogs (PG-−73.5%), followed by beta-blockers (BB−26.5%). No carbonic anhydrase inhibitors (Ca AA) or alpha-2 adrenergic agonists (alfa 2 AA) were prescribed as monotherapy. The majority of patients showed poor disease control according to all three measures. The incremental cost-effectiveness ratio (ICER) was 744 BGN for TMS and 131 BGN for NUBIT for each successfully controlled eye-far below three times GDP per capita. For ST, the ICER was negative, benefiting non-free formulations. Therapy of POAG+DED with preservative-free formulations is cost-effective according to the WHO threshold of three times GDP. The median costs of the two treatment modalities were similar. Current practice shows that patients experience a higher burden in terms of co-payment than do institutions such as the NHIF.

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Section: Discussionsupporting

confidence: 56%

Modeling the Pharmacotherapy Cost and Outcomes of Primary Open-Angle Glaucoma With Dry Eye

Tachkov

Vassilev

Kostova

2019

Front. Public Health

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“…96 Using a decision analysis model, Guedes et al suggested that, for a 5-year period in the Brazilian Public National Health System, NPDS is less costly and more effective than medical therapy when three topical medications are required. 97 However, they have excluded the cost of transportation, medical visits, examinations, and indirect costs. They also showed that the cost increases with advanced glaucoma, thus advocated to perform NPDS in the earlier stage of glaucoma.…”

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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“…Three CUAs compared surgery and topical medications. In a 2012 study adopting a Brazilian healthcare perspective, Paletta Guedes et al [18] estimated that surgery (nonpenetrating deep sclerectomy) was a dominant option versus three adjunct therapies of prostaglandin analogues with timolol and dorzolamide in patients reaching the maximum medication dose. In 2015, Kaplan et al [19] explored the cost effectiveness of the Baerveldt implant versus trabeculectomy with mitomycin from a USA societal perspective and presented a positive ICER of $US29,055 per QALY for the Baerveldt implant.…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Systematic Review of Economic Evaluations in Primary Open-Angle Glaucoma: Decision Analytic Modeling Insights

Bartelt-Hofer

Ben-Debba

Fleßa

2019

PharmacoEconomics Open

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Objective Our objective was to review, compare and gain insight into economic evaluations in primary open-angle glaucoma (POAG) with a focus on existing decision analytic models. Methods A literature review was performed using clinical and specialized databases following best practices. Relevant inclusion criteria included the development of a decision analytic model, the assessment of POAG interventions, and a full economic evaluation in terms of costs and health-related outcomes. Model inputs and settings were extracted, compared and analyzed. Main study incremental outcomes were also reported. Results The literature review identified 22 full articles in alignment with the eligibility criteria for a total of 15 countries and a wide range of years from 1983 to 2018. Interventions included as competing alternatives in the eligible studies were topical medications (33%), screening or diagnosis (33%), surgical interventions (10%), laser trabeculoplasty (10%) and minimally invasive surgeries (3%). Markov models using transition states were the most common type of modeling approach. Cost-utility models using a mid-to long-term time horizon with a national payer perspective were the most frequent type of economic evaluation identified. Model states commonly included disease severity levels, as defined by glaucoma staging systems, and other relevant events such as blindness and death. Authors did not sufficiently justify key modeling assumptions, inputs or the robustness of their findings. Conclusions Decision analytic models in POAG can reasonably guide future modeling research by revealing common practices, inputs and assumptions. Furthermore, this review revealed evidence gaps in terms of unexplored interventions and treatment sequences.

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Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

Cited by 10 publications

References 19 publications

Modeling the Pharmacotherapy Cost and Outcomes of Primary Open-Angle Glaucoma With Dry Eye

Modeling the Pharmacotherapy Cost and Outcomes of Primary Open-Angle Glaucoma With Dry Eye

Cost-effectiveness in the Treatment of Glaucoma

Systematic Review of Economic Evaluations in Primary Open-Angle Glaucoma: Decision Analytic Modeling Insights

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