PEE7: A COST COMPARISON STUDY OF COMMON PRACTICE AND BEST PRACTICE TREATMENT FOR PRIMARY OPEN-ANGLE GLAUCOMA IN THE UNITED STATES

OBJECTIVE: To compare the total, drug, and medical care costs of common practice and best practice management of primary open-angle glaucoma (POAG). METHODS: A Delphi panel of ophthalmologists specialized in glaucoma management was convened in order to delineate practice patterns representative of community physicians (common practice), and to characterize the ideal or optimal standards of care (best practice). A decision analytic approach was used to depict and economically quantify the clinical sequelae under each scenario for POAG patients initiated on medical therapy. Common and best practice decision trees were developed for prototypic agents of the most commonly used first-line classes of medications. Percentage likelihood of drug usage was determined based upon physician consensus whereas drug and surgical efficacy rates were determined based upon a composite of published data. Typical drug dosing regimens and number of medical visits, as determined by physician consensus, were used to estimate the cost of treatment. RESULTS: The total average annual cost of treatment per eye was estimated at $733.85 for common practice and $732.09 for best practice. Drug costs were estimated at $358.66 for common practice and $341.38 for best practice. Costs of medical care were estimated at $375.19 for common practice and $390.71 for best practice. Surgical costs comprised a larger proportion of medical care costs in best practice as compared to common practice (17.84% vs. 14.29%). In comparing best practice and common practice decision analyses, non-selective beta-blockers were used less often whereas alpha-2 agonists were used more often as first-line medical therapy. The probability of first-line success has been estimated at 71.2% for common practice and 72.3% for best practice. CONCLUSION: Despite higher surgical costs and improved outcomes associated with best practice management of POAG as compared with common practice, total, drug, and medical care costs of best practice were comparable to those of common practice.