September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Lifetime Costs and QALYs for POAG patients,early stage versus moderate stage treatment:A Preliminary Discrete Event Simulation cohort study
Author Affiliations & Notes
  • Hla Myint Htoon
    Statistics , Singapore Eye Research Institute, Singapore, Singapore
    Eye ACP, Duke-NUS, Singapore, Singapore
  • Duc Quang Nguyen
    Industrial and Systems Engineering, National University of Singapore, Singapore, Singapore
  • Baskaran Mani
    Glaucoma, Singapore Eye Research Institute, Singapore, Singapore
    Eye ACP, Duke-NUS, Singapore, Singapore
  • Steffen Bayer
    HSSR, Duke-NUS, Singapore, Singapore
  • Sean Shao Wei Lam
    SingHealth Health Services Research Centre, Singapore, Singapore
  • Monisha Esther Nongpiur
    Glaucoma, Singapore Eye Research Institute, Singapore, Singapore
    Eye ACP, Duke-NUS, Singapore, Singapore
  • Tin Aung
    Glaucoma, Singapore Eye Research Institute, Singapore, Singapore
    Glaucoma, Singapore National Eye Centre, Singapore, Singapore
  • Eranga Nishanthie Vithana
    Laboratory Translational Research, Singapore Eye Research Institute, Singapore, Singapore
    Eye ACP, Duke-NUS, Singapore, Singapore
  • Ecosse Luc Lamoureux
    Health Services Research, Singapore Eye Research Institute, Singapore, Singapore
    HSSR, Duke-NUS, Singapore, Singapore
  • David Matchar
    HSSR, Duke-NUS, Singapore, Singapore
  • Footnotes
    Commercial Relationships   Hla Htoon, None; Duc Quang Nguyen, None; Baskaran Mani, None; Steffen Bayer, None; Sean Lam, None; Monisha Nongpiur, None; Tin Aung, None; Eranga Vithana, None; Ecosse Lamoureux, None; David Matchar, None
  • Footnotes
    Support  SHF/HSR081/2014
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 5582. doi:
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      Hla Myint Htoon, Duc Quang Nguyen, Baskaran Mani, Steffen Bayer, Sean Shao Wei Lam, Monisha Esther Nongpiur, Tin Aung, Eranga Nishanthie Vithana, Ecosse Luc Lamoureux, David Matchar; Lifetime Costs and QALYs for POAG patients,early stage versus moderate stage treatment:A Preliminary Discrete Event Simulation cohort study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5582.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare the lifetime costs and quality-adjusted life years(QALYs)of primary open-angle glaucoma(POAG)patients commencing treatment at early (mild) and moderate stages in Singapore

Methods : The model was structured as a patient-level discrete event simulation, based on the van Gestel et.al.’s model(2012) which tracked the natural course of POAG.POAG was defined as glaucomatous optic neuropathy with compatible visual field loss.Stages of POAG were defined as per the mean deviation values on automated perimetry viz.mild(early)≥-6dB,moderate<-6dB to -12dB,and severe ≤-12dB.Life time costs included direct costs(consultation,medication,laser,surgical,hospitalization,and low vision care costs).QALYs were assessed using the Health Utility Index Mark3(HUI3).Data parameters were estimated from a Singapore POAG cohort where possible;otherwise literature estimates were used.Validation was performed based on outputs with the cohort data.Heterogeneous cohorts of 3000 patients were simulated; and lifetime costs and QALYs were accumulated.Probabilistic sensitivity analysis was used to estimate confidence ranges(CR).Sensitivity analysis was performed to account for a presumed 10-year lead-time bias for individuals with mild disease,and the possibility that due to selection bias the moderate cohort had more severe disease(adjusted by increasing the hazard ratio for worsening disease in the mild cohort to1.03)

Results : Patients with initial early POAG and who progressed to moderate stage had higher lifetime QALYs(1.51=19.7 95%CR 19.7-19.77compared to those who were initially moderate and progressed -18.22;95%CR 18.2-18.26).There was a similar pattern of lower costs for initial early POAG (S$-14,941=S$33,960;95%CR 33,866-34,054 compared to those who commenced treatment at a moderate stage -S$48,901;95%CR 48,789-49,012).The trend for lower lifetime costs and higher QALYs remained even after sensitivity analysis(Table).Cost and QALYs for baseline and sensitivity results are shown graphically(Figure)

Conclusions : Early treatment of POAG appears to have lower life time costs and higher QALYs compared to initiating treatment at a moderate stage.Our data suggest that early treatment is cost effective,perhaps even economically dominant;however,we cannot exclude the possibility that individuals with moderate POAG at onset of treatment have a more aggressive and costly disease

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

 

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