This presentation is part of: Poster Session - Public Health; Methodological Advances
SHOULD WE TREAT PEOPLE WITH OCULAR HYPERTENSION TO PREVENT GLAUCOMA?
Steven Kymes, Ph.D., Michael Kass, M.D., and Mae Gordon, Ph.D. Washington University School of Medicine, Ophtalmology and Visual Sciences, Saint Louis, MO
Purpose: The medical treatment of ocular hypertension (OH) has been shown to be efficacious in preventing primary open angle glaucoma (POAG), the most common form of glaucoma. However, treatment of OH is controversial among ophthalmologists, with some arguing that treatment prior to evidence of POAG is a waste of resources. We conducted this investigation to determine under what conditions treatment of ocular hypertension is cost-effective. Methods: A cost-utility approach was taken using a Markov decision model and data from the Ocular Hypertension Treatment Study (OHTS) augmented by a literature review. Four alternative treatment strategies were modeled: “Treat all persons with OH”, “Treat people with OH and a ³2% annual risk of POAG”, “Treat people with OH and a ³5% annual risk of POAG”, and “Treat no one”. Logistic regression using OHTS data was used to estimate the incidence of POAG among those treated and untreated, as well as the proportion of persons treated for each strategy. Precision of our results were tested with one- and two-way sensitivity analysis and Monte Carlo simulation. Results: The “Treat ³5%” strategy mildly dominated the strategy of “Treat no one”. The “Treat ³ 2%” strategy was cost-effective with an incremental cost-effectiveness ratio (ICER) of $30,950/QALY. Treatment of all persons with OH was not cost-effective with an ICER of $332,303/QALY. In sensitivity analysis, the cost of medication and the incidence of POAG were those factors that most influenced the cost-effectiveness of “Treat ³2%”. However, an extreme change in the value of these variables was required to change the decision. Monte Carlo simulation found the cost-effectiveness of the “Treat ³2%” strategy to be robust to model assumptions, and the strategy remained the most cost-effective where the cost-effectiveness threshold was $26,000/QALY or greater. Below this level, the “Treat ³ 5%” was the most cost-effective. Conclusions: While medical treatment of all people with OH to prevent POAG is not cost-effective, it is cost-effective to treat people with OH and an annual risk of POAG of at least 2%.
