Abstract
BackgroundChronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF). Health service delivery for COAG is challenging given the large number of diagnosed patients requiring lifelong periodic monitoring by hospital eye services. Yet frequent examination better determines disease worsening and speed of VF loss under treatment. We examine the cost-effectiveness of increasing frequency of VF examinations during follow-up using a health economic model.MethodsTwo different VF monitoring schemes defined as current practice (annual VF testing) and proposed practice (three VF tests per year in the first 2 years after diagnosis) were examined. A purpose written health economic Markov model is used to test the hypothesis that cost effectiveness improves by implementing proposed practice on groups of patients stratified by age and severity of COAG. Further, a new component of the model, estimating costs of visual impairment, was added. Results were derived from a simulated cohort of 10000 patients with quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) used as main outcome measures.ResultsAn ICER of £21,392 per QALY was derived for proposed practice improving to a value of £11,382 once savings for prevented visual impairment was added to the model. Proposed practice was more cost-effective in younger patients. Proposed practice for patients with advanced disease at diagnosis generated ICERs > £60,000 per QALY; these cases would likely be on the most intensive treatment pathway making clinical information on speed of VF loss redundant. Sensitivity analysis indicated results to be robust in relation to hypothetical willingness to pay threshold identified by national guidelines, although greatest uncertainty was allied to estimates of implementation and visual impairment costs.ConclusionIncreasing VF monitoring at the earliest stages of follow-up for COAG appears to be cost-effective depending on reasonable assumptions about implementation costs. Our health economic model highlights benefits of stratifying patients to more or less monitoring based on age and stage of disease at diagnosis; a prospective study is needed to prove these findings. Further, this works highlights gaps in knowledge about long term costs of visual impairment.
Highlights
Chronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF)
We previously examined the costeffectiveness of using different monitoring intervals to detect VF progression rates in all newly-diagnosed COAG patients using a health economic model developed for the purpose [19]
In total, 10,000 patients were simulated to enter into the health economic model with a positive cost differential of £298 per patient identified between proposed practice and current practice (Table 2)
Summary
Chronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF). Health service delivery for COAG is challenging given the large number of diagnosed patients requiring lifelong periodic monitoring by hospital eye services. Chronic open-angle glaucoma (COAG) is an age-related eye disease of the optic nerve [1]. Monitoring COAG in secondary care (hospital eye services) focuses upon the evaluation of the VF, assessment of the optic nerve and measurement of the elevation of intraocular pressure (IOP). The latter is the only treatable risk factor for VF deterioration (progression) [7]. In some patients only modest pharmacological treatment may be required since progression is static or slow, while in others it may be very difficult to control rapidly progressive disease
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