Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

• Published in: BMJ open 2017-01, Vol.7 (1), p.e013254-e013254
• Main Authors: Javanbakht, Mehdi, Azuara-Blanco, Augusto, Burr, Jennifer M, Ramsay, Craig, Cooper, David, Cochran, Claire, Norrie, John, Scotland, Graham
• Format: Article
• Language: English
• Subjects: Aged; Cataract Extraction - economics; Cataract Extraction - methods; Cataract Extraction - statistics & numerical data; Cataracts; Chronic illnesses; Cost analysis; Cost of Illness; Cost-Benefit Analysis; Direct Service Costs - statistics & numerical data; Eye surgery; Female; Glaucoma; Glaucoma, Angle-Closure - economics; Glaucoma, Angle-Closure - surgery; Health Economics; Humans; Lasers; Lens Implantation, Intraocular - economics; Lens Implantation, Intraocular - statistics & numerical data; Male; Markov chains; Medical treatment; Middle Aged; Patients; Primary care; Quality of Life; Quality-Adjusted Life Years; Severity of Illness Index; Society; Surveys and Questionnaires; Time-to-Treatment; Transplants & implants
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-013254

ObjectiveTo investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.DesignCost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon.Setting22 hospital eye services in the UK.PopulationMales and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).InterventionsLens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).Outcome measuresCosts of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care.ResultsThe mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.ConclusionsWe find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years.Trial registration numberISRCTN44464607; Results.