Cost-effectiveness of early detection and treatment of ocular hypertension and primary open-angle glaucoma by the ophthalmologist

Peeters, Andrea; Schouten, Jan S. A. G.; Webers, Carroll A.B.; Prins, Martin H.; Hendrikse, Fred; Severens, Johan L.

doi:10.1038/sj.eye.6702637

Cited by 22 publications

(18 citation statements)

References 55 publications

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“…One explanation for the concurrent increase in prevalence of glaucoma, cataract, and disorders of refraction with increase in utilization is that the Veteran population may be underserved and that undetected early and moderate stage disease is diagnosed with greater utilization. Diagnosis and treatment of these earlier cases may lead to prevention of blindness and ultimately cost savings 18 .…”

Section: Discussionmentioning

confidence: 99%

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans

Saeedi

Ashraf

Slade³

et al. 2017

American Journal of Ophthalmology

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Purpose To assess trends in prevalence of diagnosed ocular disease and utilization of eye care services in the VA healthcare system. Design Prevalence study Methods We performed a retrospective study of all eligible Veterans in the VA Capitol Health Care Network from 2007 to 2011. The VA database was used to abstract demographic and socioeconomic variables including age, race, gender, marital status, service connection, prescription copay, homelessness, VA facility. Primary outcome measures were prevalence of diagnosed ocular disease and utilization of eye care. Ocular diagnoses were determined by ICD-9 codes and utilization by prescription medication fills, visits to eye care clinics, and cataract surgery frequency. Results The average age of Veterans ranged from 59.8–60.9, the majority of Veterans were male (88.1– 89.8%), and there was a high proportion of African Americans (29.5–30%). The prevalence of all ocular diagnoses increased from 20.5% in 2007 to 23.3% in 2011 (P < 0.01), a 13.7% increase. Similarly, the prevalence of diagnosed cataract increased by 35.7% (P=0.02) from 7.1% in 2007 to 9.6% in 2011. Diagnosed glaucoma prevalence increased by 9.4% (P = 0.03) from 6.7 to 7.4%. The percent of patients seen in eye clinics increased 11.6%% in the five-year study period to 24.0% in FY 2011 (P = 0.05). Utilization of ophthalmic medications increased 20% (P < 0.01). The rate of cataract surgery did not change significantly during the study period. Conclusions The prevalence of diagnosed eye conditions among American Veterans is increasing, as is the utilization of eye care services. Cataract surgery rates did not increase, which may indicate a need to increase availability of these services.

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Section: Discussionmentioning

confidence: 99%

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans

Saeedi

Ashraf

Slade³

et al. 2017

American Journal of Ophthalmology

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“…(); (5) Peeters et al. (); (6) Van Gestel et al. (); (7) Dutch Healthcare Authority (Nederlandse Zorgautoriteit) (); (8) Drug information system.…”

Section: Methodsmentioning

confidence: 99%

The long term effectiveness and cost‐effectiveness of initiating treatment for ocular hypertension

Gestel

Schouten

Beckers

et al. 2013

Acta Ophthalmologica

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ABSTRACT.Purpose: To investigate the long-term health and economic consequences of direct treatment initiation in ocular hypertension patients. Methods: A cost-effectiveness analysis with a societal perspective and a lifelong horizon was performed. The primary outcomes were the incremental qualityadjusted life years (QALYs) and costs of direct pressure-lowering treatment for ocular hypertension, compared to a strategy where treatment is postponed until conversion to glaucoma has been observed. We used a decision analytic model based on individual patient simulation to forecast disease progression and treatment decisions in both strategies in a representative heterogeneous patient population and in 18 patient subgroups stratified by initial intraocular pressure and additional risk factors for conversion. Results: The incremental discounted health gain of direct treatment was 0.27 QALYs, whereas the incremental discounted costs were À€ 649 during an average lifetime of 26 years. In the simulations of patient subgroups, the model outcomes moved towards higher health gains and lower incremental costs with increasing risk of conversion in the patient population. The incremental costeffectiveness ratio of direct treatment ranged from € 15,425 per QALY gained in the lowest-risk subgroup to dominance in the highest-risk subgroup. Probabilistic sensitivity analysis indicated that uncertainty surrounding the model input parameters did not affect the conclusions. Conclusion: Direct, early, pressure-lowering treatment is a dominant costeffective treatment strategy over a strategy to start the same treatment approach later, after glaucoma has occurred for patients with ocular hypertension. Its implementation and consequences should be discussed with ophthalmologists and individual patients.

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“…Costs of medication and health care are based on several sources (Oostenbrink et al. 2001; Commissie Farmaceutische hulp (CFH) van het College voor zorgverzekeringen (Health Care Insurance Board) (2004); Peeters et al. 2008).…”

Section: Methodsmentioning

confidence: 99%

“…1996). The average treatment costs of a patient with POAG were taken from a previous study of the authors (Peeters et al. 2008).…”

Section: Methodsmentioning

confidence: 99%

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Latanoprost versus timolol as first choice therapy in patients with ocular hypertension. A cost‐effectiveness analysis

Peeters

Schouten

Severens

et al. 2010

Acta Ophthalmologica

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. Purpose: To determine the cost‐effectiveness of ocular hypertension (OH) treatment initiated with latanoprost compared to timolol. Methods: Two strategies for OH therapy are modelled, (1) ‘starting with timolol’ and (2) ‘starting with latanoprost’. Therapy can be maintained or changed dependent on the achieved intraocular pressure (IOP) and side‐effects. Adjustments of therapy to reach a target pressure involve monotherapy, combination therapy and laser. Four drugs are used: latanoprost, timolol, brimonidine and dorzolamide. Once the adjustments of therapy are completed, lifelong follow‐up with IOP‐dependent conversion to glaucoma and progression to blindness are modelled. Direct medical costs are assigned. The IOP‐lowering effect of drugs is based on meta‐analyses and applied by Monte Carlo simulation to a hypothetical cohort of patients with OH. The characteristics of the cohort, including the initial IOP distribution, are based on data of 1000 patients. Results: The IOP decreased from 25,4 mm Hg (mean) to 16.7 (±0.017) mm Hg (strategy 1) and to 16.5 (±0.013) mm Hg (strategy 2). Costs per patient within 15 months of therapy were € 367 and € 469, respectively. Lifetime blindness and costs were 0.0334 years and € 3 514 (strategy 1) and 0.0318 years and € 4 397 (strategy 2). Incremental costs per year of vision saved for strategy (2) in comparison with strategy (1) amount to, given the uncertainties in the model, approximately € 537 000. Conclusion: For saving 1 year of vision, high costs are needed when OH therapy is initiated with latanoprost compared to timolol, when the cost price of latanoprost remains high.

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Cost-effectiveness of early detection and treatment of ocular hypertension and primary open-angle glaucoma by the ophthalmologist

Abstract: Purpose To determine the most cost-effective case-finding strategy for the ophthalmologist to detect and treat ocular hypertension (OH) and primary open-angle glaucoma (POAG) at an early stage to prevent blindness. Design A Markov cost-effectiveness simulation model.

Cited by 22 publications

References 55 publications

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans

The long term effectiveness and cost‐effectiveness of initiating treatment for ocular hypertension

Latanoprost versus timolol as first choice therapy in patients with ocular hypertension. A cost‐effectiveness analysis

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