Glaucoma therapy: cost effective, good return on investment

Philadelphia-Value-based medicine analyses have indicated that glaucoma therapy has great patient benefits because it preserves their vision-which positively impacts their quality-of-life (QOL)-and it is cost effective with a high return on investment, according to Gary Brown, MD.

“Value-based medicine simply takes the evidence-based medicine and converts it to value form by adding patient QOL responses and the money returned to society by glaucoma therapies,” said Dr. Brown, Center for Value-Based Medicine, Wills Eye Institute, Philadelphia.

He said that in the 1980s, Medicare strongly considered not covering glaucoma therapy because of the supposed absence of good glaucoma therapy benefit.

To circumvent lack of coverage, Dr. Brown and colleagues conducted a value-based medicine analysis of the effects of glaucoma treatment based on what he believed to be good existing glaucoma data.

The model that Dr. Brown and his colleagues devised looked at patient value gain (benefit to QOL) and financial value (cost and return) measured by utility analysis. For example, a glaucoma diagnosis reduces the utility score to 0.97 and end-stage glaucoma reduces it to 0.52 compared with a perfect-health score of 1.

Dr. Brown recounted a 1993 report in the British Journal of Ophthalmology in which untreated patients with glaucoma were followed over time. The results showed that, for example, with an IOP of 20 mm Hg, patients would have vision for 20 years, with an IOP of 30 mm Hg, patients would have vision for 5 years, and with an IOP of 35 mm Hg or higher, patients would have vision for 2 years or less.

Practically speaking, Dr. Brown said, when timolol decreases the IOP from 25 mm Hg to 18.9 mm Hg, the patient goes from having 10.5 years of vision before end-stage glaucoma develops, to having 21.6 years of vision with an increase in the QOL of 19.9%. This compares favorably with other areas, such as administration of selective serotonin reuptake inhibitors for depression with a value gain of 21.6%, and cataract surgery with a value gain of 20.8%, he emphasized.

Regarding financial gain with improved visual acuity, depression, injuries, hospital admissions, and caregiver costs decrease while wages increase. The average 21-year treatment cost is $7,555, while the average return for preventing end-stage glaucoma is $474,715, for a return on investment of 23% annually and 6,284% over 21 years.

“Glaucoma therapy does provide great patient value compared with no treatment,” Dr. Brown said. “It is very cost effective with a good return on investment. The problem is that few know about the cost effectiveness.”

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