PMD73 - ECONOMIC IMPACT OF THE TREATMENT OF PRIMARY OPEN-ANGLE GLAUCOMA ON HIP FRACTURE: A COST-EFFECTIVENESS ANALYSIS

Abstract

World prevalence of glaucoma in people between 40-80 years is projected at 76 million people in 2020. A metanalysis found that risk of a fall in people whose visual impairment was caused by glaucoma, was greater versus population with general disability. This study estimates the cost-effectiveness of trabecular micro-bypass stent versus medications only for intraocular pressure control for patients with open-angle glaucoma. A Markov model, with stages from 0 (ocular hypertension without glaucoma) to 5 and bilateral blindness was developed inclusive of Colombian people older than 40 years in 2018 from a societal perspective, comparing trabecular micro-bypass stent versus timolol+dorzolamide+latanoprost or timolol+dorzolamide+brimatoprost or timolol+brimonidine, in terms of clinical and economic outcomes over a lifetime horizon. Both costs and health outcomes had an annual rate discount of 5%. Health outcomes were evaluated in terms of hip fractures avoided and life years gained (LYG) by deaths avoided, related with hip fractures complications. Trabecular micro-bypass costs include use of latanoprost in 80% of patients. Trabecular micro-bypass stent were estimated to have 10,569 discounted LYG more than timolol+dorzolamide+latanoprost or timolol+dorzolamide+brimatoprost, and 11,413 discounted LYG more than timolol+brimonidine. Trabecular micro-bypass stent avoided 27 hip fractures versus timolol+dorzolamide+latanoprost or timolol+dorzolamide+brimatoprost, and 29 versus timolol+brimonidine. Cumulative costs at 40 years with trabecular micro-bypass stent were € $3.756.198 lower than timolol+dorzolamide+latanoprost; € $10.539.157 lower than timolol+dorzolamide+brimatoprost; and € $6.830.957 lower than timolol+brimonidine. With a willingness-to-pay of USD $6,380 GDP per capita, trabecular micro-bypass stent has a probability of 81% to be chosen. In one-way sensitive analysis, with the lowest efficacy of trabecular micro-bypass and the highest efficacy of medications only, trabecular micro-bypass stent always was dominant. Trabecular micro-bypass stent were estimated to be a highly cost-saving strategy, because have more LYG by deaths avoided related with hip fractures complications and avoid more hip fractures.