Cost-effectiveness of Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects

Sood, Shefali; Sanchez, Victor; Heilenbach, Noah; Al-Aswad, Lama A.

doi:10.1016/j.ogla.2022.10.005

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…Considering the higher transition probabilities of PACS to PAC and PAC to PACG adapted in a previous cost-effectiveness study, 7 an additional deterministic sensitivity analysis was performed with the probabilities applied in that study.…”

Section: Discussionmentioning

confidence: 99%

“…Although a previous analysis of the cost-effectiveness of prophylactic LPI in the US demonstrated that prophylactic LPI was cost-effective, the model used a higher disease progression rate than the two recent trials. 7 In addition, no study has investigated the cost-effectiveness of prophylactic LPI in Asia despite the high prevalence of PACS and PACG in Asia. Therefore, the cost-effectiveness of prophylactic LPI should be investigated further, especially in Asian countries.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

Fujita

Konishi²,

Sakata³

et al. 2023

Preprint

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Background/Objectives: This study aimed to compare the cost-effectiveness of prophylactic laser peripheral iridotomy (LPI) with that of observation for primary angle-closure suspect (PACS) in Japan. Subjects/Methods: A Markov model was developed to compare the costs and utilities of prophylactic LPI with those of observation of 40-year-old patients with PACS. In the model with a yearly cycle over a 20-year time horizon, the disease was postulated to irreversibly progress from PACS to primary angle closure, followed by primary angle-closure glaucoma, unilateral blindness, and bilateral blindness. The parameters were estimated based on a recent randomised controlled trial and analyses of Japanese claims data. The incremental cost-effectiveness ratio was estimated from the healthcare payer’s perspective and evaluated as the willingness-to-pay 5 million Japanese Yen per quality-adjusted life-year. The observation period was shortened, and the age at entry into the cohort was changed to 50 years in the sensitivity analyses. We conducted one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations with 10 000 iterations. Results The incremental cost-effectiveness ratio of LPI was 2 270 224 Japanese Yen (14 189 pounds sterling) per quality-adjusted life-year, which was below the willingness-to-pay threshold. The ratios were approximately 4 and 8 million in the 15-year and 10-year time horizons, respectively. Increasing the age at entry had little influence on the incremental cost-effectiveness ratio. The deterministic and probabilistic sensitivity analyses indicated that the results were robust. Conclusions Our results indicate that prophylactic LPI for middle-aged patients with PACS is cost-effective in Japan.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

Fujita

Konishi²,

Sakata³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…In fact, regarding costs, another recent publication investigated the cost-effectiveness of prophylactic LPI in PACS eyes. 7 The authors simulated the progression from PACS to PAC, PACG, blindness, and death in 50-year-old individuals living in the US using Markov cycles and observed that, at 6 years, LPI was cost-effective in 92.7% and was less expensive and associated with more accrued quality-adjusted life-years.…”

Section: Jama Network Insightsmentioning

confidence: 99%

“…In our experience, when the patients understand that LPI reduces the risks of developing PAC in 69% over 14 years, that the occurrence of acute PAC, a devastating event, is reduced 5 fold, and that the complication rates of LPI are extremely low, if cost is not an issue, in a majority of the cases, the patient will elect to undergo LPI. In fact, regarding costs, another recent publication investigated the cost-effectiveness of prophylactic LPI in PACS eyes . The authors simulated the progression from PACS to PAC, PACG, blindness, and death in 50-year-old individuals living in the US using Markov cycles and observed that, at 6 years, LPI was cost-effective in 92.7% and was less expensive and associated with more accrued quality-adjusted life-years.…”

mentioning

confidence: 99%

Treatment of Primary Angle-Closure Suspect

Costa,

Asrani

2024

JAMA Ophthalmol

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“…However, despite the efficacy of prophylactic LPI, both randomised controlled trials questioned the cost-effectiveness of widespread prophylactic LPI for PACS as the incidence of PACG among patients with PACS was low and recommended that prophylactic LPI should be limited to patients with PACS at high risk of disease progression. Although a previous analysis of the cost-effectiveness of prophylactic LPI in the US demonstrated that prophylactic LPI was cost-effective, the model used a higher disease progression rate than the two recent trials [ 7 ]. In addition, no study has investigated the cost-effectiveness of prophylactic LPI in Asia despite the high prevalence of PACS and PACG in Asia.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

Fujita,

Konishi,

Sakata

et al. 2023

Eye

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Background/Objectives This study aimed to compare the cost-effectiveness of prophylactic laser peripheral iridotomy (LPI) with that of observation for primary angle-closure suspect (PACS) in Japan. Subjects/Methods A Markov model was developed to compare the costs and utilities of prophylactic LPI with those of observation of 40-year-old patients with PACS. In the model with a yearly cycle over a 20-year time horizon, the disease was postulated to irreversibly progress from PACS to primary angle closure, followed by primary angle-closure glaucoma, unilateral blindness, and bilateral blindness. The parameters were estimated mainly based on a recent randomised controlled trial and analyses of Japanese claims data. The incremental cost-effectiveness ratio was estimated from the healthcare payer’s perspective and evaluated at the willingness-to-pay 5 million Japanese Yen per quality-adjusted life-year. The observation period and the age at entry into the cohort was changed to account for a variety of clinical courses in sensitivity analyses. We conducted one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations with 10 000 iterations. Results The incremental cost-effectiveness ratio of LPI was 2,287,662 Japanese Yen (14,298 pounds sterling) per quality-adjusted life-year, which was below the willingness-to-pay threshold. The ratios were approximately 4 and 8 million in the 15-year and 10-year time horizons, respectively. Increasing the age at entry had little influence on the incremental cost-effectiveness ratio. The deterministic and probabilistic sensitivity analyses indicated that the results were robust. Conclusions Our results indicate that prophylactic LPI for middle-aged patients with PACS is cost-effective in Japan.

show abstract

Cost-effectiveness of Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects

Cited by 5 publications

References 30 publications

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

Treatment of Primary Angle-Closure Suspect

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

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