Projected cost comparison of selective laser trabeculoplasty versus glaucoma medication in the Ontario Health Insurance Plan

Abstract

Background: The projected 6-year cost comparison of primary selective laser trabeculoplasty (SLT) versus primary medical therapy in the treatment of open-angle glaucoma for Ontario patients aged 65 years or more is presented. Costs are taken from the perspective of the Ontario Health Insurance Plan at a perpatient level. Methods: The cost of each medication was obtained from the 2003 Ontario Drug Benefits formulary. The average annual cost of medications was determined by estimating the provincial prescription rate of glaucoma medications, with reference to both a volume-per-bottle study of these drugs and a study of pharmacy claims reports. A representative provincial prescription rate was calculated by reviewing 707 patient charts selected randomly from 5 ophthalmologic practices across Ontario. Medication therapies were categorized into mono-, bi-, and tri-drug therapy groups. The cost of SLT was analyzed under the following 2 scenarios. SLT rep 2y assumed a duration of 2 years before repeat SLT was necessary. SLT rep 3y assumed a duration of 3 years before repeat SLT was necessary. Bilateral 180° SLT treatment and repeatability of SLT was assumed.The cost of surgery for patients who fail SLT or medical therapy was not accounted for in this study nor was the cost of patients who required medical therapy in conjunction with SLT. Results: In the SLT rep 2y scenario, the use of primary SLT over mono-, bi-, and tri-drug therapy produced a 6-year cumulative cost savings of $206.54, $1668.64, and $2992.67 per patient, respectively. In the SLT rep 3y scenario, the use of primary SLT over mono-, bi-, and tri-drug therapy produced a 6-year cumulative cost savings of $580.52, $2042.82, and $3366.65 per patient, respectively. Interpretation: Our findings suggest that SLT as primary therapy, at a per-patient level, offers a modest potential cost saving over primary medical therapy in the management of open-angle glaucoma for Ontario patients aged 65 years or more.