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Abstract
Purpose
To perform an economic evaluation of the different treatment methods available for primary open-angle glaucoma in a Korean set-ting, including medication, selective laser trabeculoplasty, or surgery.
Methods
Three independent Markov chains were constructed for each treatment option to simulate treatment progress and to evaluate the total treatment costs for each initial strategy. The Markov chain consisted of different stages (5, 10, 20 stages), with each stage being one year. Assuming 1000 patients, a Monte Carlo simulation was iterated 1000 times to evaluate the cost of treatment over 5, 10 and 20 years.
Results
During the initial five years, medication as the initial treatment was the most expensive, whereas laser trabeculoplasty was the cheapest. After ten years, surgery became the cheapest treatment. In ten years, if the success rate of surgery is greater than 30.1%, it was more economic to choose surgery as the initial treatment. For laser trabeculoplasty, if the success rate was greater than 16.3%, laser treatment was more economical than was medication. Our model shows that only if the annual cost of medication decreases to 60,000 won or 55,000 won, then the cost of choosing medication as the initial treatment strategy will be more economical than that of laser therapy or surgery, respectively.
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 | Figures 1.Increase in costs of national health insurance. Note that there is a steady increase in both the total cost and disease (glaucoma)-specific cost from 2004 to 2007. |
 | Figure 2.The Markov model used in this study. Three independent Markov chain models were constructed for each treatment option (medication, surgery, laser) to simulate the transition of treatment progress and to evaluate the total treatment costs associated with each strategy. |
 | Figure 3.Markov probability analysis for the group primarily treated with medication (A), primarily treated with laser (B) and primarily treated with surgery (C). One stage is regarded as 1 year. Note that in panel (B), poten-tially well lasered status only appear once after initiation of the treatment as laser treatment is only performed once. The people who are eventually successfully treated with laser therapy are incorporated into successful treatment after stage 1. |
 | Figure 4.Monte Carlo for the group primarily treated with medication (A), primarily treated with laser (B) and primarily treated with surgery (C). The 10-year cumulative costs were 1,188,383 won, 835,811 won and 758,100 won for patients selecting medication, laser trabeculoplasty and operation as the initial treatment strategy, respectively. |
Table 1.
List of the eye drops with respective cost (2009 July current cost)
Table 2.
The cost for surgery and selective laser trabeculoplasty (2009 July current cost)
Table 3.
The total cost for each treatment methods during different time scales (5, 10, 20 years) (2009 July current cost)
| 5 years | 10 years | 20 years | |
|---|---|---|---|
| Medication | 689,921 | 1,188,383 | 1,706,869 |
| Laser | 656,194 | 835,811 | 901,366 |
| Surgery | 757,400 | 758,100 | 758,800 |
Table 4.
The total cost for surgery and selective laser trabeculoplasty depending on the success rate of each treatment after 10 years (2009 July current cost)
Table 5.
The total cost for medication depending on the annual cost of medication. Only if the annual cost of medication decreases to 55,000 won, then the cost of choosing medication of the initial treatment strategy will be eco-nomical than choosing laser or operation
Table 6.
The cost of each treatment options depending on the cost of laser treatment. This analysis was performed to simulate the clinical situation where selective laser trabeculoplasty is first applied over 180 degrees followed by additional trabeculoplasty over remained 180 degrees. Note the increase of the cost for laser treatment in the latter case.
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