Background/aims Advanced primary open angle glaucoma (POAG) is a lifelong condition. The aim of this study is to compare medical treatment against trabeculectomy for patients presenting with advanced POAG using an economic evaluation decision model. Methods A Markov model was used to compare the two treatments, medical treatment versus trabeculectomy for the management of advanced POAG, in terms of costs and quality-adjusted life-years (QALYs). The uncertainty surrounding the model findings was assessed using probabilistic sensitivity analysis and deterministic analysis. Data for the model came from Treatment of Advanced Glaucoma Study supplemented with data from the literature. The main outcomes of the model presented in terms of Incremental costs and QALYs based on responses to the EQ-5D-5L, Health Utilities Index-3 and a Glaucoma Utility Index. Results In the base-case analysis (lifetime horizon and EQ-5D-5L measure), participants receiving trabeculectomy had on average, an additional cost of £2687, an additional 0.28 QALYs and an incremental cost per QALY of £9679 compared with medical treatment. There was a 73% likelihood of trabeculectomy being considered cost-effective when society was willing to pay £20 000 for a QALY. Over shorter time horizons, the incremental cost per QALY gained from trabeculectomy compared with medical treatment was higher (47 663) for a 2-year time horizon. Our results are robust to changes in the key assumptions and input parameters values. Conclusion In patients presenting with advanced POAG, trabeculectomy has a higher probability of being cost-effective over a patient’s lifetime compared with medical treatment. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译：

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对于晚期原发性开角型青光眼患者，初次小梁切除术是否具有成本效益？晚期青光眼治疗研究经济模型的结果


背景/目标 晚期原发性开角型青光眼 (POAG) 是一种终生疾病。本研究的目的是使用经济评估决策模型对晚期 POAG 患者的药物治疗与小梁切除术进行比较。方法 使用马尔可夫模型比较两种治疗方法，即药物治疗与小梁切除术治疗晚期 POAG 的费用和质量调整生命年 (QALY)。使用概率敏感性分析和确定性分析评估模型结果的不确定性。该模型的数据来自晚期青光眼治疗研究并补充了文献数据。该模型的主要结果以增量成本和 QALY 形式呈现，基于对 EQ-5D-5L、健康公用事业指数 3 和青光眼公用事业指数的响应。结果 在基本案例分析（生命周期和 EQ-5D-5L 测量）中，与药物治疗相比，接受小梁切除术的参与者平均额外花费 2687 英镑，额外 0.28 QALY，每个 QALY 增量成本为 9679 英镑。当社会愿意为 QALY 支付 20,000 英镑时，小梁切除术被认为具有成本效益的可能性为 73%。在较短的时间范围内，在 2 年的时间范围内，与药物治疗相比，小梁切除术获得的每个 QALY 的增量成本更高 (47 663)。我们的结果对于关键假设和输入参数值的变化是稳健的。结论 对于晚期 POAG 患者，与药物治疗相比，小梁切除术在患者一生中具有更高的成本效益。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。