Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective
ObjectiveTo assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor.DesignDiscrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and...
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Veröffentlicht in: | British journal of ophthalmology 2016-09, Vol.100 (9), p.1263-1268 |
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creator | Hernández, R Burr, JM Vale, L Azuara-Blanco, A Cook, JA Banister, K Tuulonen, A Ryan, M |
description | ObjectiveTo assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor.DesignDiscrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year glaucoma risk is ≥6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive).SettingUK health services perspective.ParticipantsSimulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4).Main outcome measuresCosts, glaucoma detected, quality-adjusted life years (QALYs).ResultsTreating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost–utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (£86 717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence.ConclusionsFor confirmed OHT, glaucoma monitoring more frequently than every 2 years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended. |
doi_str_mv | 10.1136/bjophthalmol-2015-306757 |
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A cost-effectiveness perspective</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>PubMed Central</source><creator>Hernández, R ; Burr, JM ; Vale, L ; Azuara-Blanco, A ; Cook, JA ; Banister, K ; Tuulonen, A ; Ryan, M</creator><creatorcontrib>Hernández, R ; Burr, JM ; Vale, L ; Azuara-Blanco, A ; Cook, JA ; Banister, K ; Tuulonen, A ; Ryan, M ; Surveillance of Ocular Hypertension Study group</creatorcontrib><description>ObjectiveTo assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor.DesignDiscrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year glaucoma risk is ≥6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive).SettingUK health services perspective.ParticipantsSimulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4).Main outcome measuresCosts, glaucoma detected, quality-adjusted life years (QALYs).ResultsTreating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost–utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (£86 717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence.ConclusionsFor confirmed OHT, glaucoma monitoring more frequently than every 2 years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended.</description><identifier>ISSN: 0007-1161</identifier><identifier>EISSN: 1468-2079</identifier><identifier>DOI: 10.1136/bjophthalmol-2015-306757</identifier><identifier>PMID: 26659710</identifier><identifier>CODEN: BJOPAL</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Costs and Cost Analysis ; Disease Progression ; Female ; Health Care Costs ; Humans ; Hypertension ; Intraocular Pressure - physiology ; Male ; Middle Aged ; Monitoring ; Monitoring, Physiologic - economics ; Ocular Hypertension - diagnosis ; Ocular Hypertension - economics ; Ocular Hypertension - physiopathology ; Prediction models ; Risk factors ; Tonometry, Ocular - economics ; United Kingdom</subject><ispartof>British journal of ophthalmology, 2016-09, Vol.100 (9), p.1263-1268</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b470t-2331bddf9ef5b74e76aff55935f8a7a87206f2dc5a8963e2264836c6a79c78e33</citedby><cites>FETCH-LOGICAL-b470t-2331bddf9ef5b74e76aff55935f8a7a87206f2dc5a8963e2264836c6a79c78e33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bjo.bmj.com/content/100/9/1263.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bjo.bmj.com/content/100/9/1263.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26659710$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hernández, R</creatorcontrib><creatorcontrib>Burr, JM</creatorcontrib><creatorcontrib>Vale, L</creatorcontrib><creatorcontrib>Azuara-Blanco, A</creatorcontrib><creatorcontrib>Cook, JA</creatorcontrib><creatorcontrib>Banister, K</creatorcontrib><creatorcontrib>Tuulonen, A</creatorcontrib><creatorcontrib>Ryan, M</creatorcontrib><creatorcontrib>Surveillance of Ocular Hypertension Study group</creatorcontrib><title>Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective</title><title>British journal of ophthalmology</title><addtitle>Br J Ophthalmol</addtitle><description>ObjectiveTo assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor.DesignDiscrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year glaucoma risk is ≥6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive).SettingUK health services perspective.ParticipantsSimulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4).Main outcome measuresCosts, glaucoma detected, quality-adjusted life years (QALYs).ResultsTreating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost–utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (£86 717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence.ConclusionsFor confirmed OHT, glaucoma monitoring more frequently than every 2 years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended.</description><subject>Adult</subject><subject>Costs and Cost Analysis</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Intraocular Pressure - physiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring</subject><subject>Monitoring, Physiologic - economics</subject><subject>Ocular Hypertension - diagnosis</subject><subject>Ocular Hypertension - economics</subject><subject>Ocular Hypertension - physiopathology</subject><subject>Prediction models</subject><subject>Risk factors</subject><subject>Tonometry, Ocular - economics</subject><subject>United Kingdom</subject><issn>0007-1161</issn><issn>1468-2079</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkc1O3TAUhK0KVC60r4AssWHRFB87_ltV6KpAJRAbKnUXOY7d5CqJUzuh4u0xhCLUFStrfL4Zy2cQwkC-AjBxVu_C1M6t6YfQF5QALxgRkssPaAOlUPlK6j20IYTIAkDAATpMaZclFSA_ogMqBNcSyAb9ugljN4fYjb9xsEtvIm4fJhdnN6YujF9wG_7iYbEtNmPzLILPs2_4HNuQ5sJ57-zc3bvRpYSzMU2r_oT2vemT-_xyHqGfF9_vtlfF9e3lj-35dVGXkswFZQzqpvHaeV7L0klhvOdcM-6VkUZJSoSnjeVGacEcpaJUTFhhpLZSOcaO0OmaO8XwZ3FproYuWdf3ZnRhSRUo4BJAC_oelCpNtJAZPfkP3YUljvkjz4F5dyWBTKmVsjGkFJ2vptgNJj5UQKqnoqq3RVVPRVVrUdl6_PLAUg-ueTX-ayYDbAXqYff-2EdhJKMd</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Hernández, R</creator><creator>Burr, JM</creator><creator>Vale, L</creator><creator>Azuara-Blanco, A</creator><creator>Cook, JA</creator><creator>Banister, K</creator><creator>Tuulonen, A</creator><creator>Ryan, M</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20160901</creationdate><title>Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective</title><author>Hernández, R ; Burr, JM ; Vale, L ; Azuara-Blanco, A ; Cook, JA ; Banister, K ; Tuulonen, A ; Ryan, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b470t-2331bddf9ef5b74e76aff55935f8a7a87206f2dc5a8963e2264836c6a79c78e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Costs and Cost Analysis</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Health Care Costs</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Intraocular Pressure - physiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring</topic><topic>Monitoring, Physiologic - economics</topic><topic>Ocular Hypertension - diagnosis</topic><topic>Ocular Hypertension - economics</topic><topic>Ocular Hypertension - physiopathology</topic><topic>Prediction models</topic><topic>Risk factors</topic><topic>Tonometry, Ocular - economics</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hernández, R</creatorcontrib><creatorcontrib>Burr, JM</creatorcontrib><creatorcontrib>Vale, L</creatorcontrib><creatorcontrib>Azuara-Blanco, A</creatorcontrib><creatorcontrib>Cook, JA</creatorcontrib><creatorcontrib>Banister, K</creatorcontrib><creatorcontrib>Tuulonen, A</creatorcontrib><creatorcontrib>Ryan, M</creatorcontrib><creatorcontrib>Surveillance of Ocular Hypertension Study group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>British journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hernández, R</au><au>Burr, JM</au><au>Vale, L</au><au>Azuara-Blanco, A</au><au>Cook, JA</au><au>Banister, K</au><au>Tuulonen, A</au><au>Ryan, M</au><aucorp>Surveillance of Ocular Hypertension Study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective</atitle><jtitle>British journal of ophthalmology</jtitle><addtitle>Br J Ophthalmol</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>100</volume><issue>9</issue><spage>1263</spage><epage>1268</epage><pages>1263-1268</pages><issn>0007-1161</issn><eissn>1468-2079</eissn><coden>BJOPAL</coden><abstract>ObjectiveTo assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor.DesignDiscrete event simulation model comparing five alternative care pathways: treatment at OHT diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year glaucoma risk is ≥6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) glaucoma guidance (conservative and intensive).SettingUK health services perspective.ParticipantsSimulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4).Main outcome measuresCosts, glaucoma detected, quality-adjusted life years (QALYs).ResultsTreating at diagnosis was the least costly and least effective in avoiding glaucoma and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost–utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (£86 717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence.ConclusionsFor confirmed OHT, glaucoma monitoring more frequently than every 2 years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine glaucoma risk prediction models and value patient preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more glaucoma testing is recommended.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>26659710</pmid><doi>10.1136/bjophthalmol-2015-306757</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Costs and Cost Analysis Disease Progression Female Health Care Costs Humans Hypertension Intraocular Pressure - physiology Male Middle Aged Monitoring Monitoring, Physiologic - economics Ocular Hypertension - diagnosis Ocular Hypertension - economics Ocular Hypertension - physiopathology Prediction models Risk factors Tonometry, Ocular - economics United Kingdom |
title | Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective |
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