Cost-effectiveness Analysis of Primary Open-angle Glaucoma According to Follow-up Examination Strategy

Choi, Jin A; Jee, Donghyun; MPH,

Original Article

Annals of Optometry and Contact Lens 2018;17(4):97-103.
Published online December 25, 2018.

원발개방각녹내장에서 검사 방법과 녹내장 진행에 따른 비용효과 분석

최진아, 지동현,

가톨릭대학교 의과대학 성빈센트병원 안과 및 시과학교실

Cost-effectiveness Analysis of Primary Open-angle Glaucoma According to Follow-up Examination Strategy

Jin A Choi, Donghyun Jee, MPH

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

Received: 22 August 2018 • Revised: 13 September 2018 • Accepted: 18 September 2018

Abstract

Purpose: To evaluate the cost-utility based on the quantitative relationship between glaucoma examination method 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 (QALY) according to the glaucoma states. Glaucoma health status was divided into five 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 examination strategies.
Results: The examination strategy was divided into three levels: primary, secondary, and tertiary examination. Primary examination was defined as the intraocular pressure and optic disc examination. Secondary examination was defined as additional visual field examination to the primary examination. Tertiary examination was defined additional retinal nerve fiber layer analysis to the secondary examination. ICER of tertiary examination was 24,974,430 KRW/QALY compared secondary examination, and ICER of secondary examination was 9,866,811 KRW/QALY compared to primary examination.
Conclusions: We found that tertiary examination strategy including retinal nerve fiber layer analysis was highly cost-effective, and it is acceptable to medical system in Korea.

Key Words: Cost; Examination; Glaucoma; Strategy; Utility