Views of Glaucoma Patients on Aspects of Their Treatment: An Assessment of Patient Preference by Conjoint Analysis

Bhargava, J S; Patel, Bakula; Foss, Alexander; Avery, Anthony J; King, Anthony J

doi:10.1167/iovs.05-1244

Cited by 61 publications

(53 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5 The impact on patients is considerable, with the risks of moderate visual field loss (which affects the ability to drive) and long-term blindness reported as the most important consequences. 6 Late detection is a major risk factor for glaucoma blindness. 7 However, if glaucoma is identified in the early stages, treatment is effective at reducing the progress of the disease.…”

Section: Fundingmentioning

confidence: 99%

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

Azuara‐Blanco

Banister

Boachie

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundMany glaucoma referrals from the community to hospital eye services are unnecessary. Imaging technologies can potentially be useful to triage this population.ObjectivesTo assess the diagnostic performance and cost-effectiveness of imaging technologies as triage tests for identifying people with glaucoma.DesignWithin-patient comparative diagnostic accuracy study. Markov economic model comparing the cost-effectiveness of a triage test with usual care.SettingSecondary care.ParticipantsAdults referred from the community to hospital eye services for possible glaucoma.InterventionsHeidelberg Retinal Tomography (HRT), including two diagnostic algorithms, glaucoma probability score (HRT-GPS) and Moorfields regression analysis (HRT-MRA); scanning laser polarimetry [glaucoma diagnostics (GDx)]; and optical coherence tomography (OCT). The reference standard was clinical examination by a consultant ophthalmologist with glaucoma expertise including visual field testing and intraocular pressure (IOP) measurement.Main outcome measures(1) Diagnostic performance of imaging, using data from the eye with most severe disease. (2) Composite triage test performance (imaging test, IOP measurement and visual acuity measurement), using data from both eyes, in correctly identifying clinical management decisions, that is ‘discharge’ or ‘do not discharge’. Outcome measures were sensitivity, specificity and incremental cost per quality-adjusted life-year (QALY).ResultsData from 943 of 955 participants were included in the analysis. The average age was 60.5 years (standard deviation 13.8 years) and 51.1% were females. Glaucoma was diagnosed by the clinician in at least one eye in 16.8% of participants; 37.9% of participants were discharged after the first visit. Regarding diagnosing glaucoma, HRT-MRA had the highest sensitivity [87.0%, 95% confidence interval (CI) 80.2% to 92.1%] but the lowest specificity (63.9%, 95% CI 60.2% to 67.4%) and GDx had the lowest sensitivity (35.1%, 95% CI 27.0% to 43.8%) but the highest specificity (97.2%, 95% CI 95.6% to 98.3%). HRT-GPS had sensitivity of 81.5% (95% CI 73.9% to 87.6%) and specificity of 67.7% (95% CI 64.2% to 71.2%) and OCT had sensitivity of 76.9% (95% CI 69.2% to 83.4%) and specificity of 78.5% (95% CI 75.4% to 81.4%). Regarding triage accuracy, triage using HRT-GPS had the highest sensitivity (86.0%, 95% CI 82.8% to 88.7%) but the lowest specificity (39.1%, 95% CI 34.0% to 44.5%), GDx had the lowest sensitivity (64.7%, 95% CI 60.7% to 68.7%) but the highest specificity (53.6%, 95% CI 48.2% to 58.9%). Introducing a composite triage station into the referral pathway to identify appropriate referrals was cost-effective. All triage strategies resulted in a cost reduction compared with standard care (consultant-led diagnosis) but with an associated reduction in effectiveness. GDx was the least costly and least effective strategy. OCT and HRT-GPS were not cost-effective. Compared with GDx, the cost per QALY gained for HRT-MRA is £22,904. The cost per QALY gained with current practice is £156,985 compared with HRT-MRA. Large savings could be made by implementing HRT-MRA but some benefit to patients will be forgone. The results were sensitive to the triage costs.ConclusionsAutomated imaging can be effective to aid glaucoma diagnosis among individuals referred from the community to hospital eye services. A model of care using a triage composite test appears to be cost-effective.Future workThere are uncertainties about glaucoma progression under routine care and the cost of providing health care. The acceptability of implementing a triage test needs to be explored.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Fundingmentioning

confidence: 99%

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

Azuara‐Blanco

Banister

Boachie

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…48,49 Interestingly, it has been demonstrated that UK patients perceive this particular potential outcome of their disease to be as serious to them as the long-term risk of blindness. 50 Patients are at greater risk of motor vehicle collisions and many patients stop driving even when the visual field loss is moderate. 48,51 A plausible mechanism for issues in driving among glaucoma patients is that they have more difficulty seeing peripheral objects.…”

Section: Aspects Of Visual Disability In Glaucomamentioning

confidence: 99%

A view on glaucoma—are we seeing it clearly?

Crabb

2015

Eye

View full text Add to dashboard Cite

Successful clinical management of glaucoma should not simply be about control of intraocular pressure, but must equate to correct decisions about intensifying treatment when patients are at risk of developing 'visual disability'. Yet little is known about what visual field defects, at different stages of glaucoma, specifically affect patients' abilities to perform everyday visual tasks. One way to do this is to measure patient performance in tasks in a lab setting. Another way is to ask patients themselves. The latter can be revealing and demystify views about how patients perceive the world. This short commentary highlights some of the current research in this area.

show abstract

“…(Gurwitz et al, 1993) Paradoxically, the factors shown to be most important to glaucoma patients are long-term blindness (important to 38%) and the risk of moderate visual loss (27%), although a large percentage of patients are unwilling or unable to do what is necessary to prevent these. (Bhargava et al, 2006) Yet, knowledge of the potential consequences of glaucoma, including blindness, is similar between adherent (85%) and nonadherent (88%) patients. (Tsai, 2009;Kosoko et al, 1998) One of the most important elements of adherence is the nature of the patient-physician relationship.…”

Section: Adherence and Persistence Are Vital Elements Of Treatmentmentioning

confidence: 99%

Drops, Drops, and More Drops

Walt¹,

Alexander²

2011

Glaucoma - Current Clinical and Research Aspects

View full text Add to dashboard Cite

Views of Glaucoma Patients on Aspects of Their Treatment: An Assessment of Patient Preference by Conjoint Analysis

Abstract: To patients, the most important factors regarding glaucoma and its treatment are the risks of moderate visual loss (the ability to continue to drive) and long-term blindness. The treatment methods used are of much less importance.

Cited by 61 publications

References 20 publications

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

A view on glaucoma—are we seeing it clearly?

Drops, Drops, and More Drops

Contact Info

Product

Resources

About