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. 2008 Jan;115(1):94-8.
doi: 10.1016/j.ophtha.2007.01.040.

Cost-effectiveness of treating ocular hypertension

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Cost-effectiveness of treating ocular hypertension

William C Stewart et al. Ophthalmology. 2008 Jan.

Erratum in

  • Ophthalmology. 2008 Sep;115(9):1524. Nassar, Qasiem J [corrected to Nasser, Qasiem J]

Abstract

Purpose: To assess the cost-effectiveness of treating ocular hypertension (OHT) in the United States.

Design: A Markov model was constructed to perform a cost-effectiveness analysis.

Participants: Patients with OHT.

Methods: The health states considered were stable OHT and glaucoma. Practice patterns for the model were derived from the Ocular Hypertension Treatment Study (OHTS), and transition probabilities were derived from previous literature. Specific unit costs used for medications, patient visits, and diagnostic and therapeutic procedures were obtained from Blue Cross/Blue Shield. The time horizon was 5 years. Costs were discounted at 3% per annum.

Main outcome measure: Long-term cost effectiveness of treating OHT to prevent the development of glaucoma.

Results: The incremental cost-effectiveness ratio (ICER) for all OHT patients to prevent 1 case from progressing to primary open-angle glaucoma was $89,072. However, the minimally cost-effective ICER level after adjustment for risk factors identified by multivariate analysis in the OHTS were: 20 years above the average of 56 years, ICER of $45,155; 4 mmHg above the average pressure of 25 mmHg, ICER of $46,748; 40 microm less than the average central corneal thickness of 573 mum, ICER of $36,683; and a vertical cup-to-disc ratio of 0.2 wider than the average of 0.4, ICER of $35,633.

Conclusions: Based on the results and practice patterns of the OHTS, treating all OHT patients seems not to be cost-effective. However, treating selective OHT patients with risk factors identified in the OHTS, for example, advancing age, higher pressures, thinner central corneal thickness, and wider vertical cup-to-disc ratios, does seem to be cost-effective for preventing the onset of glaucomatous damage.

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Comment in

  • Cost-effectiveness.
    Brown GC, Brown MM. Brown GC, et al. Ophthalmology. 2008 Aug;115(8):1433; author reply 1433-4. doi: 10.1016/j.ophtha.2008.03.002. Ophthalmology. 2008. PMID: 18675701 No abstract available.
  • Cost-effectiveness.
    Lichter PR. Lichter PR. Ophthalmology. 2008 Oct;115(10):1852-3; author reply 1853. doi: 10.1016/j.ophtha.2008.05.002. Ophthalmology. 2008. PMID: 18929170 No abstract available.
  • Cost-effectiveness.
    Tuulonen A, Azuara-Blanco A. Tuulonen A, et al. Ophthalmology. 2009 Jan;116(1):166-7; author reply 167. doi: 10.1016/j.ophtha.2008.08.037. Ophthalmology. 2009. PMID: 19118707 No abstract available.

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