Price and evidence thresholds for wearable and continuous intraocular pressure monitoring in glaucoma: an early health-technology assessment in Türkiye

Wearable and continuous intraocular pressure (IOP) monitoring may reveal pressure patterns missed by office tonometry, but its effect on glaucoma progression and affordable reimbursement price remain uncertain. We developed a Markov cost-utility model comparing standard monitoring with wearable or continuous IOP monitoring added to standard care from the Turkish public payer perspective. The model evaluates a technology class rather than a specific device. Its main mechanism was a conditional reduction in progression; visit savings were secondary. Turkish costs were micro-costed from Sağlık Uygulama Tebliği (Health Implementation Communiqué) tariffs. The primary outcome was the headroom price: the maximum all-inclusive annual technology price compatible with cost-effectiveness at 1× and 3× GDP per capita. At $300/year and 15% progression reduction, the intervention gained 0.1866 QALYs at an ICER of $23,709/QALY. At 1× GDP per capita, headroom prices were $156, $231 and $305/year for 10%, 15% and 20% progression reductions. Cost-effectiveness probability was 20.3% at 1× and 89.7% at 3× GDP per capita. Progression-effect EVPPI was $97 per patient at 1× GDP. An illustrative high-risk scenario was cost-effective at $300/year with 15% progression reduction. The analysis provides device-agnostic price, trial-effect and research-priority targets rather than a universal reimbursement claim.