Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective

Research output: Contribution to journalArticlepeer-review

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Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. / Hernández, R.; Burr, J. M.; Vale, L.; Azuara-Blanco, A.; Cook, J. A.; Banister, K.; Tuulonen, A.; Ryan, M.; Botello-Pinzon, Adriana; Takwoingi, Yemisi; Vazquez-Montes, Maria; Elders, Andrew; Asaoka, Ryo; Van Der Schoot, Josine; Fraser, Cynthia; King, Anthony; Lemij, Hans; Sanders, Roshini; Vernon, Stephen; Kotecha, Aachal; Glasziou, Paul; Garway-Heath, David; Crabb, David; Perera, Rafael; Deeks, Jonathan.

In: British Journal of Ophthalmology, Vol. 100, No. 9, 01.09.2016, p. 1263-1268.

Research output: Contribution to journalArticlepeer-review

Harvard

Hernández, R, Burr, JM, Vale, L, Azuara-Blanco, A, Cook, JA, Banister, K, Tuulonen, A, Ryan, M, Botello-Pinzon, A, Takwoingi, Y, Vazquez-Montes, M, Elders, A, Asaoka, R, Van Der Schoot, J, Fraser, C, King, A, Lemij, H, Sanders, R, Vernon, S, Kotecha, A, Glasziou, P, Garway-Heath, D, Crabb, D, Perera, R & Deeks, J 2016, 'Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective', British Journal of Ophthalmology, vol. 100, no. 9, pp. 1263-1268. https://doi.org/10.1136/bjophthalmol-2015-306757

APA

Hernández, R., Burr, J. M., Vale, L., Azuara-Blanco, A., Cook, J. A., Banister, K., Tuulonen, A., Ryan, M., Botello-Pinzon, A., Takwoingi, Y., Vazquez-Montes, M., Elders, A., Asaoka, R., Van Der Schoot, J., Fraser, C., King, A., Lemij, H., Sanders, R., Vernon, S., ... Deeks, J. (2016). Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. British Journal of Ophthalmology, 100(9), 1263-1268. https://doi.org/10.1136/bjophthalmol-2015-306757

Vancouver

Author

Hernández, R. ; Burr, J. M. ; Vale, L. ; Azuara-Blanco, A. ; Cook, J. A. ; Banister, K. ; Tuulonen, A. ; Ryan, M. ; Botello-Pinzon, Adriana ; Takwoingi, Yemisi ; Vazquez-Montes, Maria ; Elders, Andrew ; Asaoka, Ryo ; Van Der Schoot, Josine ; Fraser, Cynthia ; King, Anthony ; Lemij, Hans ; Sanders, Roshini ; Vernon, Stephen ; Kotecha, Aachal ; Glasziou, Paul ; Garway-Heath, David ; Crabb, David ; Perera, Rafael ; Deeks, Jonathan. / Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective. In: British Journal of Ophthalmology. 2016 ; Vol. 100, No. 9. pp. 1263-1268.

Bibtex

@article{6fd2f9f99ac140f480f85f48931f067e,
title = "Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective",
abstract = "Objective: To assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor. Design: Discrete 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). Setting: UK health services perspective. Participants: Simulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4). Main outcome measures: Costs, glaucoma detected, quality-adjusted life years (QALYs). Results: Treating 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. Conclusions: For 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.",
keywords = "Glaucoma, Intraocular pressure, Public health",
author = "R. Hern{\'a}ndez and Burr, {J. M.} and L. Vale and A. Azuara-Blanco and Cook, {J. A.} and K. Banister and A. Tuulonen and M. Ryan and Adriana Botello-Pinzon and Yemisi Takwoingi and Maria Vazquez-Montes and Andrew Elders and Ryo Asaoka and {Van Der Schoot}, Josine and Cynthia Fraser and Anthony King and Hans Lemij and Roshini Sanders and Stephen Vernon and Aachal Kotecha and Paul Glasziou and David Garway-Heath and David Crabb and Rafael Perera and Jonathan Deeks",
year = "2016",
month = sep,
day = "1",
doi = "10.1136/bjophthalmol-2015-306757",
language = "English",
volume = "100",
pages = "1263--1268",
journal = "British Journal of Ophthalmology",
issn = "0007-1161",
publisher = "BMJ Publishing Group",
number = "9",

}

RIS

TY - JOUR

T1 - Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective

AU - Hernández, R.

AU - Burr, J. M.

AU - Vale, L.

AU - Azuara-Blanco, A.

AU - Cook, J. A.

AU - Banister, K.

AU - Tuulonen, A.

AU - Ryan, M.

AU - Botello-Pinzon, Adriana

AU - Takwoingi, Yemisi

AU - Vazquez-Montes, Maria

AU - Elders, Andrew

AU - Asaoka, Ryo

AU - Van Der Schoot, Josine

AU - Fraser, Cynthia

AU - King, Anthony

AU - Lemij, Hans

AU - Sanders, Roshini

AU - Vernon, Stephen

AU - Kotecha, Aachal

AU - Glasziou, Paul

AU - Garway-Heath, David

AU - Crabb, David

AU - Perera, Rafael

AU - Deeks, Jonathan

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objective: To assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor. Design: Discrete 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). Setting: UK health services perspective. Participants: Simulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4). Main outcome measures: Costs, glaucoma detected, quality-adjusted life years (QALYs). Results: Treating 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. Conclusions: For 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.

AB - Objective: To assess the efficiency of alternative monitoring services for people with ocular hypertension (OHT), a glaucoma risk factor. Design: Discrete 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). Setting: UK health services perspective. Participants: Simulated cohort of 10 000 adults with OHT (mean intraocular pressure (IOP) 24.9 mm Hg (SD 2.4). Main outcome measures: Costs, glaucoma detected, quality-adjusted life years (QALYs). Results: Treating 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. Conclusions: For 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.

KW - Glaucoma

KW - Intraocular pressure

KW - Public health

UR - http://www.scopus.com/inward/record.url?scp=84985946895&partnerID=8YFLogxK

U2 - 10.1136/bjophthalmol-2015-306757

DO - 10.1136/bjophthalmol-2015-306757

M3 - Article

AN - SCOPUS:84985946895

VL - 100

SP - 1263

EP - 1268

JO - British Journal of Ophthalmology

JF - British Journal of Ophthalmology

SN - 0007-1161

IS - 9

ER -