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Health economics
Research
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
  1. Mehdi Javanbakht1,
  2. Augusto Azuara-Blanco2,
  3. Jennifer M Burr3,
  4. Craig Ramsay4,
  5. David Cooper4,
  6. Claire Cochran4,
  7. John Norrie4,
  8. Graham Scotland1,4
  1. 1Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
  2. 2Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
  3. 3School of Medicine, University of St Andrews, St Andrews, UK
  4. 4Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Graham Scotland; g.scotland{at}abdn.ac.uk

Abstract

Objective To 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.

Design Cost-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.

Setting 22 hospital eye services in the UK.

Population Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).

Interventions Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).

Outcome measures Costs 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.

Results The 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.

Conclusions We 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 number ISRCTN44464607; Results.

  • Cost-effectiveness
  • Lens extraction
  • Laser peripheral iridotomy
  • randomised controlled trial
  • Angle closure glaucoma
  • QALY

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-013254

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    Footnotes

    • Contributors AA-B, JMB, CR and JN designed the research. CC managed the study. MJ analysed the economic data from the trial and developed and analysed the economic model under the supervision of GS. MJ drafted the manuscript, and all authors critically reviewed and improved it. GS is the guarantor. All authors had access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This study was funded by the UK Medical Research Council (ref G0701604) and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

    • Disclaimer The funders had no role in the study design; collection, analysis and interpretation of data; the writing of the report or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the MRC, National Institute for Health Research, the Department of Health or the Scottish Government.

    • Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: MJ, AA-B, CR, DC, CC, JN and GS have nothing to disclose. JMB reports grants from Medical Research Council, during the conduct of the study.

    • Ethics approval This study has been approved by the NRES North of Scotland Ethics Committee (Reference number: 08/S0802/153). All participants gave informed consent before taking part.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.