Abstract
BackgroundEconomic viability of treatments for primary open-angle glaucoma (POAG) should be assessed objectively to prioritise health care interventions. This study aims to identify the methods for eliciting utility values (UVs) most sensitive to differences in visual field and visual functioning in patients with POAG. As a secondary objective, the dimensions of generic health-related and vision-related quality of life most affected by progressive vision loss will be identified.MethodsA total of 132 POAG patients were recruited. Three sets of utility values (EuroQoL EQ-5D, Short Form SF-6D, Time Trade Off) and a measure of perceived visual functioning from the National Eye Institute Visual Function Questionnaire (VFQ-25) were elicited during face-to-face interviews. The sensitivity of UVs to differences in the binocular visual field, visual acuity and visual functioning measures was analysed using non-parametric statistical methods.ResultsMedian utilities were similar across Integrated Visual Field score quartiles for EQ-5D (P = 0.08) whereas SF-6D and Time-Trade-Off UVs significantly decreased (p = 0.01 and p = 0.001, respectively). The VFQ-25 score varied across Integrated Visual Field and binocular visual acuity groups and was associated with all three UVs (P ≤ 0.001); most of its vision-specific sub-scales were associated with the vision markers. The most affected dimension was driving. A relationship with vision markers was found for the physical component of SF-36 and not for any dimension of EQ-5D.ConclusionsThe Time-Trade-Off was more sensitive than EQ-5D and SF-6D to changes in vision and visual functioning associated with glaucoma progression but could not measure quality of life changes in the mildest disease stages.
Highlights
Economic viability of treatments for primary open-angle glaucoma (POAG) should be assessed objectively to prioritise health care interventions
This study demonstrates that POAG reduces visual functioning (VFL, visual acuity (VA)) and vision-related quality of life (QOL) (VFQ-25 scores), affecting the 3 Utility value (UV) to different extents: those from TTO were the most sensitive, followed by 6-dimensions utility classification system for SF-36 (SF-6D) and EuroQoL quality of life scale (EQ-5D), which was mostly unaffected
TTO utilities were highest in value and had the strongest relationship with Integrated Visual Field (IVF), VAB and the National Eye Institute 25-item visual function questionnaire (VFQ-25) composite score, implying higher overall sensitivity to glaucomainduced QOL changes
Summary
Economic viability of treatments for primary open-angle glaucoma (POAG) should be assessed objectively to prioritise health care interventions. Primary open-angle glaucoma (POAG) is the most widespread form among Western populations; if untreated, this chronic degenerative optic neuropathy induces progressive and irreversible loss of peripheral visual field (VF) with tunnel vision and, eventually, blindness. Interventions should be compared through cost-utility analysis based on Quality-Adjusted Life-Years (QALYs), a common metric of benefit whose components are life expectancy and Utility Values (UVs) [4]. The latter is a preference-based measure of the quality of life (QOL) associated with different health states, ranging between 0 (death) and 1 (perfect health) [3,5]. These changes are defined as the minimally important difference in score (i.e. the smallest difference perceived by patients as beneficial), which would call for implementing the intervention in the absence of side effects and excessive cost [7]
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