Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective

Area of Science:

• Ophthalmology
• Health Economics
• Public Health

Background:

• Ocular hypertension (OHT) is a significant risk factor for developing glaucoma.
• Efficient monitoring strategies are crucial for managing OHT and preventing vision loss.

Purpose of the Study:

• To evaluate the cost-effectiveness of different monitoring service models for individuals with OHT.
• To compare alternative care pathways against current UK National Institute for Health and Care Excellence (NICE) glaucoma guidance.

Main Methods:

• A discrete event simulation model was developed.
• Five care pathways were compared: immediate treatment, biennial monitoring, and NICE-aligned conservative and intensive monitoring.
• The model simulated 10,000 adults with OHT from a UK health service perspective, assessing costs, glaucoma detection, and quality-adjusted life years (QALYs).

Main Results:

• Immediate treatment at diagnosis was least costly but least effective in preventing glaucoma.
• Intensive NICE-guided monitoring was most costly and effective.
• Biennial monitoring offered a balance of cost and effectiveness, yielding more QALYs than NICE pathways, but was not cost-effective compared to immediate treatment.

Conclusions:

• Glaucoma monitoring for OHT more frequently than every two years is unlikely to be efficient.
• Primary treatment with minimal monitoring, focusing on intraocular pressure (IOP) responsiveness, warrants consideration.
• Further research is needed to refine risk prediction models and incorporate patient preferences; service redesign should prioritize treatment responsiveness over increased testing.