Cost-utility of primary non-pharmacological treatment of open-angle glaucoma

ABSTRACT

Objective:

To evaluate the economic impact of starting the treatment of primary open angle glaucoma with non-pharmacological strategies within the scope of reference centers for the treatment of glaucoma in the Unified Health System.

Methods:

The population of this study comes from a hypothetical cohort of patients aged 60 years with initial primary open angle glaucoma. The reference strategy (strategy 1) is based only on the use of eye drops, following the guidelines of the clinical protocol of the Brazilian Ministry of Health. Strategies 2 and 3 have the same initial treatment, with selective laser trabeculoplasty. In strategy 2, after laser failure, a trabecular device (iStent inject^®) is implanted, followed by the use of eye drops as needed, and in strategy 3, it starts with the drug treatment right after the failure of the laser. The model developed for the cost-utility analysis was the Markov model. The incremental cost-utility ratio was used as an outcome measure.

Results:

Strategies 2 and 3 generated a gain in quality of life and were dominant over strategy 1, being at the same time more effective and less costly in relation to clinical treatment. The two non-pharmacological strategies (2 and 3) proved to be cost-effective; however, the cost-effectiveness of strategy 2 suffers a significant impact according to the age of entry into the model.

Conclusion:

It is concluded that the initial non-pharmacological treatment strategies of the initial primary open angle glaucoma are cost-effective from the perspective of the Unified Health System in a horizon of the life expectancy of the population.

Keywords:
Glaucoma, open-angle; Costbenefit analysis; Quality of life; Unified Health System; Brazil