Management of Ocular Hypertension: A Cost-effectiveness Approach From the Ocular Hypertension Treatment Study

Purpose

The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of ≥24 mm Hg reduces the risk of the development of primary open-angle glaucoma (POAG) by 60%. There is no consensus on which people with ocular hypertension would benefit from treatment.

Design

Cost-utility analysis with the use of a Markov model.

Methods

We modeled a hypothetic cohort of people with IOP of ≥24 mm Hg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a ≥5% annual risk of the development of POAG; (3) treat people with a ≥2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated.

Results

The incremental cost-effectiveness ratios for treatment of people with ocular hypertension were $3670 per quality adjusted life-year (QALY) for the Treat ≥5% threshold and $42,430/QALY for the Treat ≥2% threshold. “Treat everyone” cost more and was less effective than other options. Assuming a cost-effectiveness threshold of $50,000 to 100,000/QALY, the Treat ≥2% threshold would result in the most net health benefit. The decision was sensitive to the incidence of POAG without treatment, treatment effectiveness, and the utility loss because of POAG.

Conclusion

Although the treatment of individual patients is largely dependent on their attitude toward the risk of disease progression and blindness, the treatment of those patients with IOP of ≥24 mm Hg and a ≥2% annual risk of the development of glaucoma is likely to be cost-effective. Delay of treatment for all people with ocular hypertension until glaucoma-related symptoms are present appears to be unnecessarily conservative.