Utility values among glaucoma patients: an impact on the quality of life

Abstract

Aim: To ascertain utility values and associated quality of life with different severity and duration of glaucoma among Indian patients. Methods: Utility values of 105 consecutive patients with primary glaucoma of at least 12 months' duration were evaluated in a cross sectional study. Utility values were ascertained in five groups using both the timetrade off and standard gamble methods: group 1 (best corrected visual acuity in the better eye of 6/9 or better), group 2 (best corrected visual acuity in the better eye of 6/18 to 6/12), group 3 (best corrected visual acuity in the better eye of 6/36 to6/24), group 4 (best corrected visual acuity in the better eye of 3/60 to 6/60), and group 5 (best corrected visual acuity in the better eye of 3/60 or worse). Results: The mean utility value for the glaucoma group as a whole was 0.64 (SD 0.69; 95% confidence interval (CI), 0.58 to 0.70) with the time-trade off method and 0.86 (SD 1.00; 95% CI, 0.81 to 0.90) with the standard gamble method for a gamble of death and 0.97 (SD 1.00; 95% CI, 0.94 to 0.99) for a gamble of blindness. The mean utility results by the time-trade off method were as follows: group 1 = 0.66, group 2 = 0.66, group 3 = 0.62, group 4 = 0.55, and group 5 = 0.61. The utility value was much lower (0.46) in those with no formal education or only primary education compared to those with postgraduate education (0.75) (p = 0.038). Those patients with glaucoma of less than 5 years' duration had a utility score of 0.62 while those with glaucoma for more than 10 years had a score of 0.74 (p = 0.40). Conclusions: Visual acuity loss occurring secondary to glaucoma is associated with a substantial decrease in patient utility value (and quality of life) in a developing country like India. The utility value is directly dependent on the degree of visual acuity loss associated with the disease and educational status and not on the duration of disease, the number of medications, or the visual field indices.

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

“…A reported willingness to undergo surgery where sight is already significantly deteriorated may benefit recruitment to a study recruiting patients with advanced glaucoma, who are likely to be symptomatic with their disease, 27,28 and the observation that eyes are special rather than being an obstacle to research may be used to support research, as it becomes more justifiable and essential to identify the treatment most likely to preserve this valuable resource.…”

The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation

“…The visual impaired utility state was developed using data from Table 44 and from Gupta and colleagues. 298 This study presented utility values for categories that matched glaucoma severe and visual impaired states in the present study. Then, the relative difference between these two glaucoma states from Gupta and colleagues was used to obtain the utility score for visual impaired in Table 45.…”

“…298,307 The populations used in these studies were not necessarily representative of a UK population, and as a result this evaluation used utility estimates as measured by the EQ-5D, in 264 people with glaucoma in whom severity was selfreported, apart from a subset (63 people) in whom disease severity was validated based on binocular visual field loss. This generic measure of health status may not adequately capture the utility loss due to glaucoma.…”

Quality of Life and Burden of Care in Glaucoma Patients and Their Families in a South Asian Population

“…Utility values using time trade-off method are calculated by dividing the number of years traded by the number of expected remaining years of life and subtracting this proportion from 1.0 [13]. method, revealed that visual acuity loss occurring secondary to glaucoma was associated with substantial decrease in patient utility value and QoL [13].…”