A cost-effectiveness analysis of medications compared with selective laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma.

PURPOSE: Selective laser trabeculoplasty (SLT) has increasingly been used as a first-line glaucoma treatment. To better understand its impact on the Canadian patient and health care system, a cost-effectiveness analysis was performed to compare SLT against topical eye medications for patients with newly diagnosed open-angle glaucoma. METHODS: Using a Markov model with a 20-year horizon from a health care payer perspective, the incremental cost-effectiveness ratio (ICER) of treating newly diagnosed mild open-angle glaucoma with SLT and medication was calculated. A discount rate of 1.5% was applied to all costs and health outcomes. Sensitivity and probabilistic analyses were performed to test the uncertainty of the model. RESULTS: The base case analysis indicated that patients who received the SLT treatment had a lower health care system cost of $1,671.48 and a higher quality-adjusted life year of 0.09 per patient compared with the medication treatment. As a result, the SLT treatment dominates medication treatment. The one-way cost-effectiveness sensitivity analysis showed that SLT dominates the medication treatment at all discount rates between 0% and 3%. The largest effects on the ICER value were variations in medication utility of ocular hypertension and mild glaucoma state, and SLT utility of mild glaucoma state, based on the tornado diagram. Probabilistic sensitivity analyses also demonstrated that the SLT treatment dominated the medication treatment. CONCLUSIONS: Our model suggests that SLT as the initial treatment strategy for glaucoma patients and investment in SLT could lead to improved clinical outcomes, costs, and resource utilization within the Canadian health care system.