Management of Ocular Hypertension: A Cost-effectiveness Approach From the Ocular Hypertension Treatment Study
Accepted 5 January 2006. published online 14 February 2006.
Purpose
The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of ≥24 mm Hg reduces the risk of the development of primary open-angle glaucoma (POAG) by 60%. There is no consensus on which people with ocular hypertension would benefit from treatment.
Design
Cost-utility analysis with the use of a Markov model.
Methods
We modeled a hypothetic cohort of people with IOP of ≥24 mm Hg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a ≥5% annual risk of the development of POAG; (3) treat people with a ≥2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated.
Results
The incremental cost-effectiveness ratios for treatment of people with ocular hypertension were $3670 per quality adjusted life-year (QALY) for the Treat ≥5% threshold and $42,430/QALY for the Treat ≥2% threshold. “Treat everyone” cost more and was less effective than other options. Assuming a cost-effectiveness threshold of $50,000 to 100,000/QALY, the Treat ≥2% threshold would result in the most net health benefit. The decision was sensitive to the incidence of POAG without treatment, treatment effectiveness, and the utility loss because of POAG.
Conclusion
Although the treatment of individual patients is largely dependent on their attitude toward the risk of disease progression and blindness, the treatment of those patients with IOP of ≥24 mm Hg and a ≥2% annual risk of the development of glaucoma is likely to be cost-effective. Delay of treatment for all people with ocular hypertension until glaucoma-related symptoms are present appears to be unnecessarily conservative.
aDepartment of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
bDivision of Biostatistics, Washington University School of Medicine, St Louis, Missouri
cBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
Inquiries to Steven M. Kymes, PhD, Washington University School of Medicine, Department of Ophthalmology and Visual Sciences, 660 South Euclid, Campus Box 8096, St Louis, MO 63110-1093
Supported by Awards to the Washington University School of Medicine Department of Ophthalmology and Visual Sciences from the National Eye Institute, the National Center on Minority Health and Health Disparities, National Institutes of Health (grants EY09341 and EY09307), and unrestricted grants from Merck Research Laboratories and Pfizer, Inc; and by Awards to the Washington University Department of Ophthalmology and Visual Sciences from Research to Prevent Blindness, Inc, and the National Institutes of Health (P30 EY 02687) Core grant.
For a complete list of OHTS investigators, please see the OHTS website at https://vrcc.wustl.edu
ABSTRACT