An Economic Analysis of Selective Laser Trabeculoplasty versus Topical Prostaglandin Analogues as Initial therapy for Primary Open-Angle Glaucoma in a Tertiary Government Hospital in the Philippines
James Michael D. Jacomina, MD, John Mark S. de Leon, MD,
Jose Maria D. Martinez, MD-MBA
Department of Health (DOH) Eye Center, East Avenue Medical Center, Quezon City
Correspondence: James Michael D. Jacomina, MD
Email Address: firstname.lastname@example.org
Clinic Address: DOH Eye Center, East Avenue Medical Center, Diliman, Quezon
City Clinic Phone Number: +639178552948
Disclosures: The authors have no financial interests or conflicts of interest to report.
Objective: This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).
Method: This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, costeffectiveness and cost-utility in the setting of a tertiary government hospital.
Results: Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.
Conclusion: In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.
Keywords: Economic analysis, cost-effectiveness, cost-utility, glaucoma, selective laser trabeculoplasty, prostaglandin analogues, quality adjusted life years, Philippines
Philipp J Ophthalmol 2023;48:4-9