Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105046

Steven Kymes, PhD, MHA, Department of Ophthalmology, Washington University School of Medicine, Campus Box 8096, 660 South Euclid Ave., St. Louis, MO 63110, 314-747-4612, kymes@vrcc.wustl.edu and Mae O. Gordon, PhD, Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8096, St. Louis, MO 63110.

Introduction: The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with an intraocular pressure (IOP) > 24 mm Hg may reduce the risk of primary open angle glaucoma (POAG) by 60%. However, treatment to prevent POAG remains controversial due to the modest impact of early POAG on quality of life. Methods: We conducted an economic evaluation to determine under what conditions medical treatment of people with ocular hypertension to prevent glaucoma is cost-effective. Methods: We constructed a Markov model to compare four alternative treatment thresholds: “Treat no one”, “Treat people with a >5% annual risk of developing POAG”, “Treat people with a >2% annual risk of developing POAG”, and “Treat everyone”. Outcome measures considered were the incremental cost effectiveness ratio (ICER) and incidence of blindness. Results: The ICER for an annual risk of POAG > 5% was $577/QALY. The ICER for the > 2% threshold was $37,959 per QALY. Treatment of all people with ocular hypertension was not cost-effective. The lifetime incidence of unilateral blindness was 5.3%, 4.5%, 3.4%, and 2.8% for the “Treat No One”, “Treat > 5%”, “Treat > 2%” and “Treat everyone” thresholds respectively. Results were sensitive to assumptions of the incidence of POAG without treatment, the cost of medication, and the utility loss due to POAG. Conclusion: Treatment of people with ocular hypertension to prevent glaucoma is likely to be cost-effective if treatment is limited to people with an annual risk of developing glaucoma of no more than 2%.

Learning Objectives: At the conclusion of this session the participant will be able to

• Describe the key elements that determine the cost-effectiveness of the treatment of ocular hypertension
• Identify those with ocular hypertension who most benefit from treatment.
• Describe the public health benefit associated with selective treatment of ocular hypertension.

Keywords: Cost-Effectiveness, Vision Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation