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Ernesto D. Golez, III, Tarek A. Shazly, Alessandro Porta, Fabio Ferentini, Mark A. Latina; The Cost Effectiveness And Duration Of Effectiveness Of SLT As Primary And Secondary Therapy Relative To Medications In The Treatment Of Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5966.
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To assess the cost effectiveness and duration of effectiveness of selective laser trabeculoplasty relative to medications when used as primary therapy and when used as secondary treatment for primary open angle glaucoma.
Retrospective, chart review of primary open angle glaucoma patients who underwent SLT between January 2002 and October 2011 was performed. Patients were divided into 2 groups: SLT primary therapy (Group 1), and SLT secondary therapy (Group 2). The number and types of medications pre and post SLT were determined. The duration of SLT effectiveness was defined as the interval between performing SLT and adding new medication or other surgical intervention. Data were logged every 3 months for 6 months and every 6 months thereafter. The average monthly cost ofeach medication was calculated using the average wholesale price (AWP) in the United States. The cost of SLT was based on Medicare reimbursements of $367.44. An average monthly cost of the SLT was determined based on the mean duration of effectiveness of SLT for each group. Also, the average cost of each medication and the number of months required to achieve cost equivalence for each medication type were determined.
A total of 170 eyes of 109 patients were included in the study, with 83 eyes in Group 1 and 87 eyes in Group 2. In Group 1, SLT was effective for a mean duration of 29 months at a mean cost of $27.97/month while in Group 2, SLT was effective for a mean duration of 26 months at a mean cost of $33.57/month. In Group 2, the mean duration of SLT effectiveness was inversely related to the number of medications prior to SLT. In Group 2, by reducing the number of medications after SLT, there was an average cost savings of $16/month in 66/87 eyes (76%). Fifty one percent of group 2 patients were using one medication prior to SLT. Also, in Group 2 patients, the mean duration of SLT effectiveness exceeded the months required to achieve cost equivalence for B-blockers,topical CAI’s, PGE’s and Alpha agonist-beta blocker combination. There was no cost benefit in patients using alpha agonists and topical CAI-beta blocker combination prior to SLT. This may bedue to the small sample size of this subgroup of those patients.
SLT achieved the lowest per month cost at $27.97/ month as primary therapy due to a longer duration of effectiveness without the need for medications compared to SLT as secondary therapy. Also, the duration of effectiveness of SLT in patients where medications were reduced, exceeding the months required to achieve cost equivalence for most types of medications.
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