WASHINGTON—Current patterns of care and treatment for glaucoma are a cost-effective way to slow or prevent vision loss and should be continued, according to a CDC funded study published in the May issue of Ophthalmology, the journal of the American Academy of Ophthalmology.

While previous research established that screening was effective in detecting glaucoma and preventing the disease’s progression, no research had linked these impacts to cost-effective improvements in the patient’s visual functionality and quality of life.

The study, however, found that routine patient assessment for glaucoma during scheduled visits to an eye care provider, followed by the treatment of patients with detectable symptoms of glaucoma, were cost-effective even when the entire costs of the eye assessment was attributed to glaucoma and when a conservative impact of treatment was assumed. “It is cost effective to treat glaucoma...so if you are an eye care provider and you have a patient who has visual field loss related to glaucoma, you ought to go ahead and treat them and not wait for the condition to get worse,” said David Rein, Ph.D., a senior research economist at RTI and the study’s lead author.

Glaucoma Patterns of Care and Treatment Are Cost Effective, Study Shows

For the study, researchers from RTI International, Duke University, Harvard University and the CDC developed a randomized, computerized model that simulated glaucoma incidence, progression, diagnoses, and treatment of 20 million people and considered their outcomes over a window of analysis starting from age 50 to 100 (or death). Those diagnosed and treated for primary open angle glaucoma were compared with those who were not treated.

The study found that with no treatment, a person with POAG would experience 5.2 years of visual impairment or blindness, on average, compared with 2.6 years for patients with treatment assumed to be conservatively effective.

The peak age group for visual impairment and blindness among those in the study was 75 to 79; with not reatment, 24.6% of people would have significant loss of vision, versus 12.1% (conservative efficacy) or 4.8% (optimistic efficacy) for treated patients. The calculations to determine cost effectiveness included ophthalmic costs, nursing home costs attributable to vision problems, and total costs, as well as per-person Quality-Adjusted Life Years (QALY) and years of unimpaired vision. QALY is a formula used by researchers to measure a person’s health improvement, general functionality and well being following a medical intervention and is factored over the person’s estimated remaining years of life.

The lower the dollar amount calculated for a QALY, the higher the value of the intervention. Compared with no treatment, the study found that routine POAG care cost $46,000 per QALY gained (conservative) or $28,000 per QALY gained (optimistic.)

“This is a good use of resources to treat people,” Dr. Rein said of the results.

Preventing Progression of Glaucoma

In 2005, the United States Preventive Services Task Force (USPSTF) determined that there was insufficient evidence to recommend for or against screening adults for glaucoma. The Task Force’s main objection was that although screening could be shown to detect cases and treatment could be shown to prevent progression, there was a lack of evidence proving that preventing progression led to improvement in quality of life at a reasonable cost.

The authors stated in the study that their results “suggest preventing progression is in fact cost-effective, certainly after the point when glaucoma is diagnosed, but also after attributing all the costs of routine eye assessments to glaucoma.”

Dr. Rein said that it is often difficult to attach quantifiable standardized metrics that measure the impact of morbidity losses associated with a condition. That has been an issue for policymakers in quantifying the benefits of preventing the progression of glaucoma. “It is assumed that going blind from visual field loss would be something that you would want to avoid, but the ability to quantify those losses is limited. So, in the absence of quantifiable metrics to attach to the disability losses, for many people the default has been conservative and to not to rush in to try to avoid something that is difficult to quantifiably link to a patient’s facility losses,” he said.

In closing, Dr. Rein reaffirmed that the findings support the cost-effectiveness of the glaucoma treatment recommendations outlined in the American Academy of Ophthalmology’s Preferred Practice Patterns.