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

J. M. Burr, L. Vale, A. Azuara-Blanco, J. A. Cook, K. Banister, A Tuulonen, M. Ryan, Surveillance of Ocular Hypertension Study Group

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Abstract

Objective To assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor.

Design Discrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year glaucoma risk is ≥6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive).

Setting UK health services perspective.

Participants Simulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4).

Main outcome measures Costs, glaucoma detected, quality-adjusted life years (QALYs).

Results Treating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost–utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (£86 717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence.

Conclusions For confirmed OHT, glaucoma monitoring more frequently than every 2 years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended.
Original languageEnglish
Pages (from-to)1263-1268
Number of pages6
JournalBritish Journal of Ophthalmology
Volume100
Issue number9
Early online date11 Dec 2015
DOIs
Publication statusPublished - Sep 2016

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    Burr, J. M., Vale, L., Azuara-Blanco, A., Cook, J. A., Banister, K., Tuulonen, A., Ryan, M., & Surveillance of Ocular Hypertension Study Group (2016). Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. British Journal of Ophthalmology, 100(9), 1263-1268. https://doi.org/10.1136/bjophthalmol-2015-306757