Cost-utility Analysis of Primary Open-angle Glaucoma according to Follow-up Observation Period

Jin A Choi; Jin Woo Kwon; Donghyun Jee

doi:10.3341/jkos.2018.59.9.842

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Choi, Kwon, and Jee: Cost-utility Analysis of Primary Open-angle Glaucoma according to Follow-up Observation Period

Original Article

J Korean Ophthalmol Soc 2018;59(9):842-847.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.9.842

Cost-utility Analysis of Primary Open-angle Glaucoma according to Follow-up Observation Period

Jin A Choi, MD, PhD, Jin Woo Kwon, MD, Donghyun Jee, MD, PhD, MPH

Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Donghyun Jee, MD, PhD, MPH Department of Ophthalmology, The Catholic University of Korea St. Vincent's Hospital, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: 82-31-249-7343, Fax: 82-31-249-6225 E-mail: doj087@mail.catholic.ac.kr

Received 19 April 2018 Revised 20 June 2018 Accepted 23 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the cost-utility based on the quantitative relationship between glaucoma follow-up and glaucoma progression.

Methods

The Markov model was constructed and analyzed to determine the cost-effectiveness of primary open-angle glaucoma. The Markov model set up a virtual cohort of Korean over 40 years of age with early glaucoma. The costs associated with glaucoma treatment were assessed from a social point of view, and the utility was calculated using the quality adjusted life years according to the glaucoma states. Glaucoma health status was divided into 5 stages (early, middle, late, unilateral, bilateral blindness). The transition probability was set in one direction from mild to severe, and the length of each cycle was set at one year. The incremental cost effectiveness ratio (ICER) was calculated and compared with each other different follow-up periods. Sensitivity analysis was conducted to determine how the uncertainty of the variables used in this study affected the outcome.

Results

ICER of 3-month follow-up was 28,244,398 won/quality adjusted life years (QALY) compared 6-month follow-up, and ICER of 6-month follow-up was 13,615,443 won/QALY compared to 12-month follow-up. If the probability of progression of glaucoma in 6-months follow-up observations increases by more than 10% over 3-month periodic follow-up and the progression probability of 12-month follow-up increases by more than 15% follow-up compared to 3-months follow-up, 3-months follow-up was found to be a cost-effective strategy. On the other hand, 6-month follow-up was found to be cost-effective if probability of progression of 6-month follow-up was less than 10% increase of 3-month follow-up and 15% increase of 6-months follow-up.

Conclusions

Cost-effective follow-up strategies differed according to the probability of progression of glaucoma, and 3-month or 6-month follow-up strategies were cost-effective and acceptable in Korea's health care system.

Keywords: Cost, Follow-up, Glaucoma, Utility

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Figure 1.

Cost-effectiveness of glaucoma patients with medication according to different follow-up periods: 3-month, 6-month, and 12-months intervals. 3 months follow up strategy showed cost of 21,091,762 won and effectiveness of 12.5 quality adjusted life years, as 1 year follow up strategy showed cost of 13,868,566 won and effectiveness of 12.1 quality adjusted life years. FU = follow up; Yr = year; M = months.

Figure 2.

Two-way sensitivity analysis of cost-effectiveness of glaucoma patients with medication on ratio of transition probability by 6-month and 12-month over 3-month follow-up periods. If the probability of progression of glaucoma in 6-months follow-up observations increases by more than 10% over 3-month periodic follow-up and the progression probability of 12-month follow-up increases by more than 15% fol-low-up compared to 3-months follow-up, 3-months follow-up was found to be a cost-effective strategy. M = months; yr = year; FU = follow up; WTP = willingness to pay.

Table 1.

Costs used in the model

	Parameter	Value (KRW)
Medication	Prostaglandin	16,583
	Cosopt	23,570
	Alphagan	16,075
	Total cost of medication	56,228
	Nonofficial medication	107,334
Examination	Slit	2,287
	Tono	2,275
	Gonio	7,837
	Discphoto	14,150
	OCT	62,400
	VF	24,375
	Total cost of examination	113,324
	Total cost of examination	224,361
Visit	1st visit	16,800
	Transportation	1,981
	Societal cost of visit time	32,195
	Frequency of visit/year	4 per year
	Total inpatient days	3 days
	Total outpatient days	2 days
Treatment	Laser complication	1,000,000
	Surgery complication	2,000,000
	Trabe	445,287
	Trasportation for admission	n 10,061
	Admission cost	413,205
	Time cost for admission	307,245
	Outpatient nurse	249,910
	Inpatient nurse	210,000

KRW = Korean won; OCT = optical coherence tomography; VF = visual field.

Table 2.

Utilities and other parameters used in the model

	Parameter	Value
Utilities	Mild glaucoma	0.92
	Moderate glaucoma	0.89
	Severe glaucoma	0.86
	Unilateral blindness	0.47
	Bilateral blindness	0.26
	Dead	0
Transition probabilities	Progression from less to more severe OAG state	0.1
	Progression from mild to moderate OAG, medication	0.0914

OAG = open angle glaucoma.

Table 3.

Cost-effectiveness of treating newly diagnosed mild open-angle glaucoma using different strategies of follow-up schedules with 3, 6, and 12 months intervals

Strategy	Cost (KRW)	Incremental cost (KRW)	Effectiveness (QALYs)	Incremental effectiveness (QALYs)	ICER (KRW/QALYs)
FU 1 year	13,868,566		12.1
FU 6 months	16,276,298	2,407,732	12.3	0.2	13,615,443
FU 3 months	21,091,762	4,815,464	12.5	0.2	28,244,398

KRW = Korean won; QALY = quality adjusted life years; ICER = incremental cost effectiveness ratio; FU = follow up.

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