Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: An economic evaluation based on data from the EAGLE trial

Mehdi Javanbakht, Augusto Azuara-Blanco, Jennifer M. Burr, C R Ramsay, David Cooper, Claire Cochran, John Norrie, Graham Scotland

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Abstract

Objective: To investigate the cost effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.
Design: Cost effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed up for 36 months and data on health service utilisation and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5 and 10-year time horizon.
Setting: 22 hospital eye services in the United Kingdom.
Population: Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).
Interventions: Lens extraction compared to standard care (i.e. laser iridotomy followed by medical therapy and glaucoma surgery).
Outcome measures: Costs of primary and secondary health care utilisation (UK NHS perspective), quality adjusted life years (QALYs) and the incremental cost effectiveness ratio (ICER) for lens extraction versus standard care.
Results: The mean age of participants was 67.5 (8.42), 57.5% were female, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. Mean health service costs were higher in patients randomized to lens extraction: £2,467 versus £1,486. Mean adjusted QALYs were also higher with early lens extraction: 2.602 versus 2.533. The ICER for lens extraction versus standard care was £14,284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7,090 per QALY gained by 5 years, and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.
Conclusions: We find that lens extraction has a 67-89% chance of being cost effective at 3 years, and that it may be cost saving by 10 years.
Original languageEnglish
Article numbere013254
JournalBMJ Open
Volume7
Early online date13 Jan 2017
DOIs
Publication statusEarly online date - 13 Jan 2017

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