Investigate cost-effectiveness (CE) of prophylactic laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS).
Cost-effectiveness analysis utilizing Markov models
Patients with narrow angles (PACS)
Progression from PACS through 4 states (PAC, PAC glaucoma, blindness, death) was simulated using Markov cycles. The cohort entered at 50 years and received LPI or no treatment. Transition probabilities were from published models and risk reduction of LPI was from the ZAP trial. We estimated costs at Medicare rates and previously published utility values were used to calculate quality-adjusted-life-year (QALY). Incremental cost-effectiveness ratios (ICER) were evaluated at $50,000. Probabilistic sensitivity analyses (PSA) addressed uncertainty.
Main outcome measures
Total cost, QALY, ICER
Over 2 years, the ICER for the LPI cohort was >$50,000. At 6 years, the LPI cohort was less expensive with more accrued QALY. In PSA, the LPI arm was cost-effective in 24.7% of iterations over 2 years and 92.7% over 6 years. The most sensitive parameters were probability of progressing to PAC and cost and number of annual office visits.
By 6 years, prophylactic LPI is cost-effective. Rate of progressing to PAC and differing practice patterns most impacted CE. With uncertainty of management of narrow angles, cost may be a decision management tool for providers.