Abstract
Glaucoma is the leading cause of irreversible blindness in Brazil. Its prevalence and incidence tend to increase significantly in the future, mainly due to the population increase and aging. The scarcity of health care resources and the increasing costs in health require a balanced analysis of health interventions and an efficient allocation of resources. The cost-effectiveness and cost-utility studies are important because they allow a comparison between different alternatives in terms of both their costs and their results. For this purpose, mathematical modeling (such as Markov modeling) is commonly used as the analytical method. The literature, including in Brazil, has plenty of evidence of cost-effectiveness and cost-utility in glaucoma. This article aims to review in a practical way the concepts of economic evaluation in health, describe the different types of health economic studies, as well as the results of cost-effectiveness and cost-utility studies in glaucoma in the literature.
Highlights
Understanding the cost of a certain condition is crucial to the economic planning of efforts aimed at reducing the burden of this condition. 1 Several countries have already explored and characterized the cost of visual impairment and blindness.[2,3,4]An increased prevalence of glaucoma is expected in the years as the population and life expectancy grow. 5-6 its economic impact is significantly increased
The results of this study showed that the type of treatment, whether clinical, surgical or laser, has no impact on the utility values.[28]
Medeiros and colleagues developed a risk calculator based on the work of Ocular Hypertensive Treatment Study (OHTS) able to estimate the risk of developing glaucoma in 5 years according to the age, intraocular pressure (IOP), central corneal thickness, aspect of the optic nerve, Pattern Standard Deviation (PSD) index of the computerized campimetry, and presence of Diabetes mellitus.[30]
Summary
Understanding the cost of a certain condition is crucial to the economic planning of efforts aimed at reducing the burden of this condition. 1 Several countries have already explored and characterized the cost of visual impairment and blindness.[2,3,4]. According to Doshi and Singh, from the economic point of view, it would be more cost-effective to treat only those patients at high and moderate risk of developing glaucoma.[8] Medeiros and colleagues developed a risk calculator based on the work of Ocular Hypertensive Treatment Study (OHTS) able to estimate the risk of developing glaucoma in 5 years according to the age, IOP, central corneal thickness, aspect of the optic nerve, Pattern Standard Deviation (PSD) index of the computerized campimetry, and presence of Diabetes mellitus.[30] Kymes et al used the Markov model to discover that the treatment of ocular hypertension with a high risk of developing glaucoma (IOP > 24 mmHg and risk of progression > 2%) was cost-effective from the individual point of view, when measured in QALYs.[31] They considered that the treatment of all ocular hypertension was not cost-efetivo.[31] The same result was found by Stewart et al.[32] These authors suggest selecting and treating only patients at high risk of conversion, for example: old age, high IOP, and low corneal thickness, and increased excavation of the optic nerve.[32].
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