Cost-utility analysis of commonly used anti-glaucoma interventions for mild-to-moderate primary open-angle glaucoma patients in rural and urban China

Ruyue Li; Kaiwen Zhang; Zhecheng Lu; Dapeng Mou; Jin Wang; Huiqi Li; Sujie Fan; Ningli Wang; Hanruo Liu

doi:10.1136/bmjopen-2023-073219

Cost-utility analysis of commonly used anti-glaucoma interventions for mild-to-moderate primary open-angle glaucoma patients in rural and urban China

BMJ Open. 2023 Sep 6;13(9):e073219. doi: 10.1136/bmjopen-2023-073219.

Authors

Ruyue Li^{1

2}, Kaiwen Zhang^{1

2}, Zhecheng Lu^{1

2}, Dapeng Mou², Jin Wang^{1

2}, Huiqi Li³, Sujie Fan⁴, Ningli Wang^{5

2}, Hanruo Liu^{5

2}

Affiliations

¹ Beijing Institute of Ophthalmology, Beijing, China.
² Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.
³ School of Medical Technology, Beijing Institute of Technology, Beijing, China.
⁴ Handan City Eye Hospital, Handan, China.
⁵ Beijing Institute of Ophthalmology, Beijing, China hanruo.liu@hotmail.co.uk wningli@vip.163.com.

Abstract

Objective: An increasing number of studies have explored the clinical effects of antiglaucoma surgical procedures; however, economic evidence was scarce. We aimed to compare the cost-effectiveness between maximal medical treatment (MMT) and commonly used surgical procedures (trabeculectomy, Ahmed glaucoma valve implantation, gonioscopy-assisted transluminal trabeculotomy and ab interno canaloplasty).

Design and setting: A Markov model study.

Participants: A hypothetical cohort of 100 000 patients with mild-to-moderate primary open-angle glaucoma (POAG).

Outcomes: Data were obtained from public sources. The main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years (QALYs). Sensitivity analyses were conducted to verify the robustness and sensitivity of base-case results.

Main results: Both cumulative costs and QALYs gained from surgical procedures (US$6045-US$13 598, 3.33-6.05 QALYs) were higher than those from MMT (US$3117-US$6458, 3.14-5.66 QALYs). Compared with MMT, all surgical procedures satisfied the cost-effectiveness threshold (lower than US$30 501 and US$41 568 per QALY gained in rural and urban settings, respectively). During the 5-year period, trabeculectomy produced the lowest ICUR (US$21 462 and US$15 242 per QALY gained in rural and urban settings, respectively). During the 10-year-follow-up, trabeculectomy still produced the lowest ICUR (US$13 379 per QALY gained) in urban setting; however, gonioscopy-assisted transluminal trabeculotomy (US$19 619 per QALY gained) and ab interno canaloplasty (US$18 003 per QALY gained) produced lower ICURs than trabeculectomy (US$19 675 per QALY gained) in rural areas. Base-case results were most sensitive to the utilities and costs of initial treatment and maintenance.

Conclusions: The long-term cost-effectiveness of commonly used surgical procedures could be better than the short-term cost-effectiveness for mild-to-moderate POAG patients in China. Health economic studies, supported by more rigorous structured real-world data, are needed to assess their everyday cost-effectiveness.

Keywords: Health economics; Public health; SURGERY.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China
Cost-Benefit Analysis
Glaucoma*
Glaucoma, Open-Angle* / drug therapy
Glaucoma, Open-Angle* / surgery
Humans
Trabeculectomy*