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KMID : 0360220100510060865
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Journal of the Korean Ophthalmological Society
2010 Volume.51 No. 6 p.865 ~ p.874
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Economic Evaluation of Different Initial Treatments for Primary Open Angle Glaucoma: A Markov Model
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Kwag Tong-Yun
Kwag Jee-Hyun
Kim Yeon-Deok
Yim Hye-Bin
Paik Hae-Jung
Park Chi-Jun
Aman Shah B. Abdul Majid
Kang Kui-Dong
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Abstract
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Purpose: To perform an economic evaluation of the different treatment methods available for primary open-angle glaucoma in a Korean setting, including medication, selective laser trabeculoplasty, or surgery.
Methods: Three independent Markov chains were constructed for each treatment option to simulate treatment progress and to evaluate the total treatment costs for each initial strategy. The Markov chain consisted of different stages (5, 10, 20 stages), with each stage being one year. Assuming 1000 patients, a Monte Carlo simulation was iterated 1000 times to evaluate the cost of treatment over 5, 10 and 20 years.
Results: During the initial five years, medication as the initial treatment was the most expensive, whereas laser trabeculoplasty was the cheapest. After ten years, surgery became the cheapest treatment. In ten years, if the success rate of surgery is greater than 30.1%, it was more economic to choose surgery as the initial treatment. For laser trabeculoplasty, if the success rate was greater than 16.3%, laser treatment was more economical than was medication. Our model shows that only if the annual cost of medication decreases to 60,000 won or 55,000 won, then the cost of choosing medication as the initial treatment strategy will be more economical than that of laser therapy or surgery, respectively.
Conclusions: The economic value of choosing laser therapy as the initial treatment strategy is the greatest over five simulated-years, whereas surgery had the greatest economic value over more than ten years.
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KEYWORD
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Economic evaluation, Glaucoma, Laser trabeculoplasty, Markov model, Monte Carlo simulation
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