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Stein JD, Kim DD, Peck WW, Giannetti SM, Hutton DW. Cost-effectiveness of Medications Compared With Laser Trabeculoplasty in Patients With Newly Diagnosed Open-Angle Glaucoma. Arch Ophthalmol. 2012;130(4):497–505. doi:10.1001/archophthalmol.2011.2727
Author Affiliations: Departments of Ophthalmology and Visual Sciences (Dr Stein) and Health Management and Policy (Mr Kim and Dr Hutton), and College of Pharmacy (Mssrs Peck and Giannetti), University of Michigan, Ann Arbor.
Objective To determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP).
Methods Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only.
Results The incremental cost-effectiveness of LTP over no treatment is $16 824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14 179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value.
Conclusions Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.
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