Cost-effectiveness of Medications Compared With Laser Trabeculoplasty in Patients With Newly Diagnosed Open-Angle Glaucoma

Stein, Joshua D.; Kim, David D.; Peck, Will W.; Giannetti, Steven M.; Hutton, David

doi:10.1001/archophthalmol.2011.2727

Cited by 71 publications

(56 citation statements)

References 31 publications

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“…77 Our model is novel, in that we were able to project medication and trabeculectomy costs over the lifetime of patients while modelling the health-care costs associated with OHT and OAG health states separately, using LiGHT trial data. As discussed, our utility values for health states are similar to those quoted in other studies; 73,95,103 modifying these has limited impact on the results, particularly as using published data means that we are unable to use utilities specific to trial arms.…”

Section: Economic Evaluationsupporting

confidence: 59%

“…The values were similar to values published elsewhere in the literature; for example, Hernández et al 103 reported utilities of 0.8015, 0.8015, 0.7471 and 0.7133 for OHT and mild, moderate and severe glaucoma, respectively. Stein et al 95 reported values of 0.92, 0.89 and 0.86 for mild, moderate and severe glaucoma, respectively. The values reported in Hernández et al 103 were used in a sensitivity analysis for the model.…”

Section: Literature Searchmentioning

confidence: 97%

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Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT

Gazzard

Konstantakopoulou

Garway-Heath

et al. 2019

Health Technol Assess

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Background Newly diagnosed open-angle glaucoma (OAG) and ocular hypertension (OHT) are habitually treated with intraocular pressure (IOP)-lowering eyedrops. Selective laser trabeculoplasty (SLT) is a safe alternative to drops and is rarely used as first-line treatment. Objectives To compare health-related quality of life (HRQoL) in newly diagnosed, treatment-naive patients with OAG or OHT, treated with two treatment pathways: topical IOP-lowering medication from the outset (Medicine-1st) or primary SLT followed by topical medications as required (Laser-1st). We also compared the clinical effectiveness and cost-effectiveness of the two pathways. Design A 36-month pragmatic, unmasked, multicentre randomised controlled trial. Settings Six collaborating specialist glaucoma clinics across the UK. Participants Newly diagnosed patients with OAG or OHT in one or both eyes who were aged ≥ 18 years and able to provide informed consent and read and understand English. Patients needed to qualify for treatment, be able to perform a reliable visual field (VF) test and have visual acuity of at least 6 out of 36 in the study eye. Patients with VF loss mean deviation worse than –12 dB in the better eye or –15 dB in the worse eye were excluded. Patients were also excluded if they had congenital, early childhood or secondary glaucoma or ocular comorbidities; if they had any previous ocular surgery except phacoemulsification, at least 1 year prior to recruitment or any active treatment for ophthalmic conditions; if they were pregnant; or if they were unable to use topical medical therapy or had contraindications to SLT. Interventions SLT according to a predefined protocol compared with IOP-lowering eyedrops, as per national guidelines. Main outcome measures The primary outcome was HRQoL at 3 years [as measured using the EuroQol-5 Dimensions, five-level version (EQ-5D-5L) questionnaire]. Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness and safety. Results Of the 718 patients enrolled, 356 were randomised to Laser-1st (initial SLT followed by routine medical treatment) and 362 to Medicine-1st (routine medical treatment only). A total of 652 (91%) patients returned the primary outcome questionnaire at 36 months. The EQ-5D-5L score was not significantly different between the two arms [adjusted mean difference (Laser-1st – Medicine-1st) 0.01, 95% confidence interval (CI) –0.01 to 0.03; p = 0.23] at 36 months. Over 36 months, the proportion of visits at which IOP was within the target range was higher in the Laser-1st arm (93.0%, 95% CI 91.9% to 94.0%) than in the Medicine-1st arm (91.3%, 95% CI 89.9% to 92.5%), with IOP-lowering glaucoma surgery required in 0 and 11 patients, respectively. There was a 97% probability of Laser-1st being more cost-effective than Medicine-1st for the NHS, at a willingness to pay for a quality-adjusted life-year of £20,000, with a reduction in ophthalmology costs of £458 per patient (95% of bootstrap iterations between –£585 and –£345). Limitation An unmasked design, although a limitation, was essential to capture any treatment effects on patients’ perception. The EQ-5D-5L questionnaire is a generic tool used in multiple settings and may not have been the most sensitive tool to investigate HRQoL. Conclusions Compared with medication, SLT provided a stable, drop-free IOP control to 74.2% of patients for at least 3 years, with a reduced need for surgery, lower cost and comparable HRQoL. Based on the evidence, SLT seems to be the most cost-effective first-line treatment option for OAG and OHT, also providing better clinical outcomes. Future work Longitudinal research into the clinical efficacy of SLT as a first-line treatment will specify the long-term differences of disease progression, treatment intensity and ocular surgery rates between the two pathways. Trial registration Current Controlled Trials ISRCTN32038223. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 31. See the NIHR Journals Library website for further project information.

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Section: Economic Evaluationsupporting

confidence: 59%

Section: Literature Searchmentioning

confidence: 97%

Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT

Gazzard

Konstantakopoulou

Garway-Heath

et al. 2019

Health Technol Assess

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“…The device is portable, the procedure does not require glaucoma subspecialty training to perform, treated eyes require no postoperative anti-inflammatory therapy, 14,15 and the treatment is cost-effective when compared to medical therapy in both developed and developing countries. 16,17 …”

Section: Discussionmentioning

confidence: 99%

“…SLT provides IOP reduction similar to a prostaglandin analogue, 11,12 has a favorable safety profile, 13 is portable, does not require glaucoma subspecialty training to perform, requires no postoperative anti-inflammatory therapy, 14,15 and is cost-effective when compared to medical therapy in both developed and developing countries. 16,17 …”

Section: Introductionmentioning

confidence: 99%

West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma

Realini

Shillingford-Ricketts²,

Burt

et al. 2017

American Journal of Ophthalmology

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Purpose To characterize the 12-month intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty (SLT) as sole therapy for primary open-angle glaucoma (POAG) in an Afro-Caribbean population. Design Stepped-wedge trial. Methods Subjects in St. Lucia and Dominica with established POAG were randomized to prompt washout of IOP-lowering medications followed by SLT, 3-month delay followed by washout and SLT, or 6-month delay followed by washout and SLT. Baseline IOP was obtained on two different days after washout. Bilateral 360-degree SLT was performed in one session. Post-treatment assessments took place 1 hour, 1 week, and 3, 6, 9, and 12 months post-SLT. The main outcome measure was SLT success (defined as IOP ≤ target IOP in both eyes) at 12 months. Target IOP was a 20% or greater reduction in IOP from post-washout baseline. Results Overall, 72 underwent SLT treatment. Mean IOP at enrollment was 15.4 ± 3.6 mmHg in right eyes and 15.4 ± 3.6 mmHg in left eyes, which rose to 21.0 ± 3.3 mmHg and 20.9 ± 3.0 mmHg, respectively, after washout. Mean IOP at 3, 6, 9 and 12 months ranged from 12.5 mmHg to 14.5 mmHg (29.7% to 39.5%; p<0.0001 in each eye at each time point). The 12-month success rate was 78%. Transient photophobia and discomfort were common. Conclusions SLT monotherapy safely provides significant IOP reduction in Afro-Caribbean eyes with POAG. This treatment can play a significant role in preventing glaucoma vision loss and blindness in people of African descent living in resource-limited regions.

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“…Major questions-such as how cost-effective a particular medication is compared to other treatment modalities such as laser trabeculoplasty or surgery and which medication is most cost-effective in lowering IOP-still lack a definite answer, although some evidence exists suggesting that first-line PGA monotherapy provides greater value than laser trabeculoplasty assuming optimal medication adherence and is the more cost-effective treatment compared to other types of available glaucoma medications. 16,[45][46][47][48] This highlights the need for unbiased, well-designed economic studies to establish the relative cost-effectiveness and impact on quality of life of the treatment regimens for OAG or OHT and to identify opportunities for further savings.…”

Section: Discussionmentioning

confidence: 99%

<p>Current Knowledge and Attitudes Concerning Cost-Effectiveness in Glaucoma Pharmacotherapy: A Glaucoma Specialists Focus Group Study</p>

Feldman¹,

Cioffi²,

Liebmann³

et al. 2020

OPTH

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Background: Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians' knowledge and attitudes about cost-effectiveness in glaucoma treatment. Purpose: This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of costeffectiveness decisions; the clinical utility of cost-effectiveness studies; and the costeffectiveness of available treatments. Methods: Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions. Results: Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identified medications, diagnostics, office visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decisionmaking but identified the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to efficacy, participants felt patient adherence and side-effect profile should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context. Conclusion: Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater efficacy and favorable side-effect and adherence profiles may help optimize cost-effectiveness. Future studies should include: clinicians' perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model.

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Cost-effectiveness of Medications Compared With Laser Trabeculoplasty in Patients With Newly Diagnosed Open-Angle Glaucoma

Cited by 71 publications

References 31 publications

Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT

Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT

West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma

<p>Current Knowledge and Attitudes Concerning Cost-Effectiveness in Glaucoma Pharmacotherapy: A Glaucoma Specialists Focus Group Study</p>

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