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

R. Hernández, 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
DOIs
Publication statusPublished - 1 Sep 2016

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Ocular Hypertension
Glaucoma
Cost-Benefit Analysis
Quality-Adjusted Life Years
National Institutes of Health (U.S.)
Delivery of Health Care
Intraocular Pressure
Costs and Cost Analysis
Secondary Care
Patient Preference
National Health Programs
Health Care Costs
Health Services
Primary Health Care
Outcome Assessment (Health Care)

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Hernández, R., Burr, J. M., Vale, L., Azuara-Blanco, A., Cook, J. A., Banister, K., ... 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
Hernández, R. ; Burr, J. M. ; Vale, L. ; Azuara-Blanco, A. ; Cook, J. A. ; Banister, K. ; Tuulonen, A. ; Ryan, M. ; Surveillance of Ocular Hypertension Study group. / Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. In: British Journal of Ophthalmology. 2016 ; Vol. 100, No. 9. pp. 1263-1268.
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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.",
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Hernández, R, Burr, JM, Vale, L, Azuara-Blanco, A, Cook, JA, 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, vol. 100, no. 9, pp. 1263-1268. https://doi.org/10.1136/bjophthalmol-2015-306757

Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. / Hernández, R.; Burr, J. M.; Vale, L.; Azuara-Blanco, A.; Cook, J. A.; Banister, K.; Tuulonen, A.; Ryan, M.; Surveillance of Ocular Hypertension Study group.

In: British Journal of Ophthalmology, Vol. 100, No. 9, 01.09.2016, p. 1263-1268.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective

AU - Hernández, R.

AU - Burr, J. M.

AU - Vale, L.

AU - Azuara-Blanco, A.

AU - Cook, J. A.

AU - Banister, K.

AU - Tuulonen, A.

AU - Ryan, M.

AU - Botello-Pinzon, Adriana

AU - Takwoingi, Yemisi

AU - Vazquez-Montes, Maria

AU - Elders, Andrew

AU - Asaoka, Ryo

AU - Van Der Schoot, Josine

AU - Fraser, Cynthia

AU - King, Anthony

AU - Lemij, Hans

AU - Sanders, Roshini

AU - Vernon, Stephen

AU - Kotecha, Aachal

AU - Glasziou, Paul

AU - Garway-Heath, David

AU - Crabb, David

AU - Perera, Rafael

AU - Deeks, Jonathan

AU - Surveillance of Ocular Hypertension Study group

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

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U2 - 10.1136/bjophthalmol-2015-306757

DO - 10.1136/bjophthalmol-2015-306757

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EP - 1268

JO - British Journal of Ophthalmology

JF - British Journal of Ophthalmology

SN - 0007-1161

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