Management of Ocular Hypertenion: A Cot-effectivene Approach From the Ocular Hypertenion Treatment tudy

Purpoe The Ocular Hypertenion Treatment tudy (OHT) demontrated that medical treatment of people with intraocular preure (IOP) of ≥24 mm Hg reduce the rik of the development of primary open-angle glaucoma (POAG) by 60%. There i no conenu on which people with ocular hypertenion would benefit from treatment. Deign Cot-utility analyi with the ue of a Markov model. Method We modeled a hypothetic cohort of people with IOP of ≥24 mm Hg. Four treatment threhold were conidered: (1) Treat no one; (2) treat people with a ≥5% annual rik of the development of POAG; (3) treat people with a ≥2% annual rik of the development of POAG, and (4) treat everyone. The incremental cot-effectivene ratio wa evaluated. Reult The incremental cot-effectivene ratio for treatment of people with ocular hypertenion were $3670 per quality adjuted life-year (QALY) for the Treat ≥5% threhold and $42,430/QALY for the Treat ≥2% threhold. “Treat everyone” cot more and wa le effective than other option. Auming a cot-effectivene threhold of $50,000 to 100,000/QALY, the Treat ≥2% threhold would reult in the mot net health benefit. The deciion wa enitive to the incidence of POAG without treatment, treatment effectivene, and the utility lo becaue of POAG. Concluion Although the treatment of individual patient i largely dependent on their attitude toward the rik of dieae progreion and blindne, the treatment of thoe patient with IOP of ≥24 mm Hg and a ≥2% annual rik of the development of glaucoma i likely to be cot-effective. Delay of treatment for all people with ocular hypertenion until glaucoma-related ymptom are preent appear to be unnecearily conervative.