Economic considerations of the diagnosis and management for glaucoma in the developed world

This review evaluates the last 18-month literature related to costs and glaucoma. The emphasis is to look at evidence as a big picture and evaluate the critical points and challenges in methodology, current knowledge and future research.

On the basis of simulation models, treating glaucoma appears to be cost-effective compared with no treatment. The results of the simulation models are, however, not consistent regarding when to treat ocular hypertension and when comparing different therapeutic interventions. Most models simulated starting treatment with prostaglandins compared with other medications, whereas one study simulated also initial laser therapy which appeared to be cost saving compared with medical therapy. The models utilized input data both from randomized controlled trials (ideal outcomes) and observational studies (with incomplete and selective reporting). Models suffer from unreliability of data, for example data from randomized diagnostic trials, empirical data of utility values and glaucoma-induced visual disability are limited.

As the number of economic evaluations increases, the interpretation and evaluation of their extensive reporting appears very challenging. The published studies highlight the range of uncertainties due to the shortages of our current knowledge and evidence. There is a need for reliable and 'realistic' data for economic evaluations, preferably data from pragmatic randomized trials of 'usual patients'. Similar to emphasizing the cost-effectiveness of care, there is a need to evaluate the expected payback and cost-effectiveness of research interventions. However, even high-quality evidence cannot help our patients if we do not adopt cost-effective interventions.