Cost-Effectiveness of Early Surgical or Medical Therapy for Primary Open-Angle Glaucoma: A Decision Analytic Model

ABSTRACT

PURPOSE: To estimate the cost-effectiveness of treatment with early surgical therapy for primary open-angle glaucoma compared with early medical therapy. METHODS: The hypothetical patient was treated with early surgical or early medical therapy. Relevant costs were obtained from 2002 National Health Insurance data. The success rate of each therapy was obtained from previous reports. Cost-effective Markov model was created using the medical decision analysis program. Markov approach simulated disease progression. Matrix calculation and Monte Carlo simulation were used to determine whether there was a significant difference in quality-of-life adjusted years (QALYs) gained between surgical and medical therapy. RESULTS: In Moorfields study cost-effectiveness for early surgical therapy and medical monotherapy were 110, 161 W/QALYs and 189, 616 W/QALYs, respectively. In the Collaborative Initial Glaucoma Treatment Study (CIGTS) cost-effectiveness for early surgical therapy and medical monotherapy were 153, 578 W/QALYs and 201, 353 W/QALYs, respectively. Matrix calculation and Monte Carlo simulation showed that early surgical therapy was superior cost-effective treatment to medical therapy. CONCLUSIONS: By cost-effective Markov medical decision model, early surgical therapy for primary open-angle glaucoma is a cost-effective treatment option and is superior to medical therapy.