Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: An economic evaluation based on data from the EAGLE trial

Mehdi Javanbakht, Augusto Azuara-Blanco, Jennifer M Burr, Craig Ramsay, David Cooper, Claire Cochran, John Norrie, Graham Scotland

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Abstract

Objective To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.
Design Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon.
Setting: 22 hospital eye services in the United Kingdom.
Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).
Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery).
Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care.
Results: The mean age of participants was 67.5 (8.42), 57.5% were female, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.
Conclusions We find that lens extraction has a 67-89% chance of being cost effective at 3 years, and that it may be cost saving by 10 years.
Original languageEnglish
Article numbere013254
JournalBMJ Open
Volume7
Issue number1
DOIs
Publication statusPublished - 1 Jan 2017

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Angle Closure Glaucoma
Intraocular Lens Implantation
Lenses
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Health Services
Patient Acceptance of Health Care
Secondary Care
Glaucoma
Health Care Costs
Primary Health Care
Lasers
Arm
Randomized Controlled Trials
Outcome Assessment (Health Care)
Health

Keywords

  • cost-effectiveness
  • lens extraction
  • laser peripheral iridotomy
  • randomised controlled trial
  • angle closure glaucoma
  • QALY

Cite this

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma : An economic evaluation based on data from the EAGLE trial. / Javanbakht, Mehdi; Azuara-Blanco, Augusto; Burr, Jennifer M; Ramsay, Craig; Cooper, David; Cochran, Claire; Norrie, John; Scotland, Graham.

In: BMJ Open, Vol. 7, No. 1, e013254, 01.01.2017.

Research output: Contribution to journalArticle

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abstract = "Objective To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon. Setting: 22 hospital eye services in the United Kingdom.Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery).Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care.Results: The mean age of participants was 67.5 (8.42), 57.5{\%} were female, 44.6{\%} had both eyes eligible, 1.4{\%} were of Asian ethnicity and 35.4{\%} had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67-89{\%} chance of being cost effective at 3 years, and that it may be cost saving by 10 years.",
keywords = "cost-effectiveness, lens extraction, laser peripheral iridotomy, randomised controlled trial, angle closure glaucoma, QALY",
author = "Mehdi Javanbakht and Augusto Azuara-Blanco and Burr, {Jennifer M} and Craig Ramsay and David Cooper and Claire Cochran and John Norrie and Graham Scotland",
note = "This study was funded by the UK Medical Research Council (ref G0701604), and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are both funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in the study design; collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the MRC, National Institute for Health Research, the Department of Health, or the Scottish Government.",
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AU - Burr, Jennifer M

AU - Ramsay, Craig

AU - Cooper, David

AU - Cochran, Claire

AU - Norrie, John

AU - Scotland, Graham

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N2 - Objective To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon. Setting: 22 hospital eye services in the United Kingdom.Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery).Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care.Results: The mean age of participants was 67.5 (8.42), 57.5% were female, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67-89% chance of being cost effective at 3 years, and that it may be cost saving by 10 years.

AB - Objective To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon. Setting: 22 hospital eye services in the United Kingdom.Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery).Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care.Results: The mean age of participants was 67.5 (8.42), 57.5% were female, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67-89% chance of being cost effective at 3 years, and that it may be cost saving by 10 years.

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KW - laser peripheral iridotomy

KW - randomised controlled trial

KW - angle closure glaucoma

KW - QALY

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