Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma

Ashleigh Kernohan; Tara Homer; Hosein Shabaninejad; Anthony J. King; Jemma Hudson; Gordon Fernie; Augusto Azuara-Blanco; Jennifer Burr; John M. Sparrow; David Garway-Heath; Keith Barton; John Norrie; Graeme Maclennan; Luke Vale

doi:10.1136/bjo-2021-320887

Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma

Ashleigh Kernohan^*, Tara Homer, Hosein Shabaninejad, Anthony J. King, Jemma Hudson, Gordon Fernie, Augusto Azuara-Blanco, Jennifer Burr, John M. Sparrow, David Garway-Heath, Keith Barton, John Norrie, Graeme Maclennan, Luke Vale

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Synopsis Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research.

Background/aims Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy.

Methods A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained.

Results Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study.

Conclusion This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon.

Original language	English
Article number	bjo-2021-320887
Pages (from-to)	1452-1457
Number of pages	6
Journal	British Journal of Ophthalmology
Volume	107
Issue number	10
Early online date	26 Jul 2022
DOIs	https://doi.org/10.1136/bjo-2021-320887
Publication status	Published - Oct 2023

Keywords

Glaucoma
Treatment Medical
Treatment Surgery

Access to Document

10.1136/bjo-2021-320887Licence: CC BY

Kernohan_2022_BJO_Cost-effectiveness_CC
Copyright © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Final published version, 1.15 MBLicence: CC BY

Cite this

Kernohan, A., Homer, T., Shabaninejad, H., King, A. J., Hudson, J., Fernie, G., Azuara-Blanco, A., Burr, J., Sparrow, J. M., Garway-Heath, D., Barton, K., Norrie, J., Maclennan, G., & Vale, L. (2023). Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma. British Journal of Ophthalmology, 107(10), 1452-1457. Article bjo-2021-320887. https://doi.org/10.1136/bjo-2021-320887

@article{48e61e6e890e4d07a971fd8303cff635,

title = "Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma",

abstract = "Synopsis Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research.Background/aims Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy.Methods A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained.Results Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study.Conclusion This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon.",

keywords = "Glaucoma, Treatment Medical, Treatment Surgery",

author = "Ashleigh Kernohan and Tara Homer and Hosein Shabaninejad and King, {Anthony J.} and Jemma Hudson and Gordon Fernie and Augusto Azuara-Blanco and Jennifer Burr and Sparrow, {John M.} and David Garway-Heath and Keith Barton and John Norrie and Graeme Maclennan and Luke Vale",

note = "Funding Information: This work was supported by the National Institute for Health Research Health Technology Assessment Programme, grant number [12/35/38]. ",

year = "2023",

month = oct,

doi = "10.1136/bjo-2021-320887",

language = "English",

volume = "107",

pages = "1452--1457",

journal = "British Journal of Ophthalmology",

issn = "0007-1161",

publisher = "BMJ Publishing Group Ltd",

number = "10",

}

Kernohan, A, Homer, T, Shabaninejad, H, King, AJ, Hudson, J, Fernie, G, Azuara-Blanco, A, Burr, J, Sparrow, JM, Garway-Heath, D, Barton, K, Norrie, J, Maclennan, G & Vale, L 2023, 'Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma', British Journal of Ophthalmology, vol. 107, no. 10, bjo-2021-320887, pp. 1452-1457. https://doi.org/10.1136/bjo-2021-320887

TY - JOUR

T1 - Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma

AU - Kernohan, Ashleigh

AU - Homer, Tara

AU - Shabaninejad, Hosein

AU - King, Anthony J.

AU - Hudson, Jemma

AU - Fernie, Gordon

AU - Azuara-Blanco, Augusto

AU - Burr, Jennifer

AU - Sparrow, John M.

AU - Garway-Heath, David

AU - Barton, Keith

AU - Norrie, John

AU - Maclennan, Graeme

AU - Vale, Luke

N1 - Funding Information: This work was supported by the National Institute for Health Research Health Technology Assessment Programme, grant number [12/35/38].

PY - 2023/10

Y1 - 2023/10

N2 - Synopsis Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research.Background/aims Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy.Methods A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained.Results Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study.Conclusion This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon.

AB - Synopsis Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research.Background/aims Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy.Methods A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained.Results Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study.Conclusion This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon.

KW - Glaucoma

KW - Treatment Medical

KW - Treatment Surgery

U2 - 10.1136/bjo-2021-320887

DO - 10.1136/bjo-2021-320887

M3 - Article

C2 - 35882513

SN - 0007-1161

VL - 107

SP - 1452

EP - 1457

JO - British Journal of Ophthalmology

JF - British Journal of Ophthalmology

IS - 10

M1 - bjo-2021-320887

ER -

Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma

Abstract

Keywords

Access to Document

Fingerprint

Cite this