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Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity
Ricardo Augusto Paletta Guedes1, Vanessa Maria Paletta Guedes, Carlos Eduardo de Mello Gomes
1Statistics Department and Public Health Department, Federal University of Juiz de Fora Ophthalmology Department, Santa Casa de Misericórdia Hospital Glaucoma Department, Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil.
Medicine
|December 30, 2016
Summary
Laser and medical treatments are cost-effective for early primary open-angle glaucoma (POAG). For moderate and advanced stages, laser and surgery offer the best value, with younger patients benefiting most from earlier intervention.
Area of Science:
- Ophthalmology
- Health Economics
- Public Health
Background:
- Primary open-angle glaucoma (POAG) poses a significant public health challenge, necessitating cost-effective treatment strategies.
- The Brazilian Public Health System (SUS) requires evidence-based guidance for managing POAG within its Glaucoma Referral Centers.
Purpose of the Study:
- To identify the most cost-effective treatment strategies for primary open-angle glaucoma (POAG) in Brazil.
- To analyze treatment costs and quality-adjusted life years (QALY) from the perspective of the Brazilian Public Health System (SUS).
Main Methods:
- A cost-effectiveness analysis using three Markov models for early, moderate, and advanced POAG stages.
- Evaluation of treatment strategies including observation, medication, laser therapy, and surgery.
- Calculation of incremental cost-effectiveness ratios (ICERs) and direct medical costs over the average life expectancy.
Main Results:
- Laser and medical treatments were cost-effective for early POAG, yielding significant quality of life gains over observation.
- For moderate POAG, laser and surgery demonstrated high cost-effectiveness, while medical treatment was more expensive.
- All strategies for advanced POAG were cost-effective. Younger patient age correlated with greater cost-effectiveness for laser and surgical interventions.
Conclusions:
- All evaluated POAG treatment strategies improved quality of life and were cost-effective.
- Optimal cost-effectiveness varied by glaucoma severity, suggesting stage-specific preferred treatment pathways.
- A ranked approach based on cost-effectiveness ratios should guide treatment selection for each glaucoma stage.
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