Cost-Utility of Prostaglandin Analogues Compared to Beta Blockers as First-Line Medication for Treating Primary Open Angle Glaucoma in Ghana — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Cost-Utility of Prostaglandin Analogues Compared to Beta Blockers as First-Line Medication for Treating Primary Open Angle Glaucoma in Ghana
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
1 Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
Ghana ranks among the countries most affected by glaucoma in the world. It is estimated that 700,000 people in Ghana are affected by glaucoma, out of which 60,000 people are already blind. In recent years, there has been a growing concern that anti-glaucoma medications listed on the country’s health insurance medicines list are not adequate to manage the disease. This has led to calls from different stakeholders for prostaglandin analogues to be added to the medicines list. However, the cost-effectiveness of this medication is yet to be established. The objective of this study, therefore, was to establish the cost- effectiveness of prostaglandin analogues as first-line medication for treating primary open angle glaucoma in Ghana. A Markov Model was constructed to assess the life-time cost-effectiveness of treating a hypothetical cohort of one thousand 55-year-old POAG patients with prostaglandin analogues compared to beta blockers. The effect of parameter uncertainty on cost-effectiveness was explored through one-way, two-way, and probabilistic sensitivity analyses. Compared to beta blockers, prostaglandin analogues resulted in an incremental cost-effectiveness ratio (ICER) of USD 11,600; based on an estimated incremental gain of 105 quality-adjusted life years (QALYs), at an additional cost of USD 1,222,400. The ICER was not sensitive to the age of the cohort, the cost of prostaglandin analogues, or the probability of developing asthma. However, the ICER was sensitive to the age of the cohort and the cost of prostaglandin analogues when varied simultaneously. Given the existing evidence, prostaglandin analogue is not a cost-effective alternative to beta blockers as a first-line treatment for POAG in Ghana. The study, however, shows that further research to reduce decision uncertainty would be necessary if expected cost of research does not exceed USD 131 billion.
Potter, A., Debrah, O., Ashun, J. and Blanchet, K. (2013) Eye Health Systems Assessment (EHSA): Ghana Country Report.
World Glaucoma Association (2010) WGA African Glaucoma Summit: The 1st African Glaucoma Summit.
Quigley, H.A. and Broman, A.T. (2006) The Number of People with Glaucoma Worldwide in 2010 and 2020. British Journal of Ophthalmology, 90, 262-267. https://doi.org/10.1136/bjo.2005.081224
Guzek, J.P., Anyomi, F.K., Fiadoyor, S. and Nyonator, F. (2005) Prevalence of Blindness in People over 40 Years in the Volta Region of Ghana. Ghana Medical Journal, 39, 55-62.
About 700,000 People in Ghana Suffer Glaucoma. http://www.ghanaweb.com/GhanaHomePage/health/About-700-000-people-in-Ghana-suffer-glaucoma-349940
Cook, C. (2009) Glaucoma in Africa: Size of the Problem and Possible Solutions. Journal of Glaucoma, 18, 124-128. https://doi.org/10.1097/IJG.0b013e318189158c
Koffuor, G.A., Ababio-Danso, B., Gyanfosu, L. and Amoateng, P. (2012) The Efficacy of NHIS-Listed Anti-Glaucoma Drugs in the Management of Primary Open-Angle Glaucoma. Journal of Medical and Biomedical Sciences, 1.
Ministry of Health (Ghana) (2010) Standard Treatment Guidelines. 6th Edition, Yamens Press Ltd., Accra.
Rathore, K.S. and Nema, R.K. (2009) Medical Management of Glaucoma: An Overview. International Journal of PharmTech Research, 1, 863-869.
Thylefors, B. and Négrel, A.D. (1994) The Global Impact of Glaucoma. Bulletin of the World Health Organization, 72, 323-326.
Ophthalmology, A.A.O. (2009) Practical Ophthalmology: A Manual for Beginning Residents. 6th Edition, 6th Revised Edition, American Academy of Ophthalmology, San Francisco.
Carroll, N.J. and Johnson, C.A. (2013) Visual Field Testing: From One Medical Student to Another. http://webeye.ophth.uiowa.edu/eyeforum/tutorials/VF-testing/
Shafranov, G. (2011) Essentials of Automated Perimetry. In: Walsh, T.J., Ed., Visual Fields Examination and Interpretation, 3rd Edition, Oxford University Press, Oxford.
Heijl, A., et al. (2002) Reduction of Intraocular Pressure and Glaucoma Progression: Results from the Early Manifest Glaucoma Trial. Archives of Ophthalmology, 120, 1268-1279.
Ting, N.S., Li Yim, J.F. and Ng, J.Y. (2014) Different Strategies and Cost-Effectiveness in the Treatment of Primary Open Angle Glaucoma. ClinicoEconomics and Outcomes Research, 6, 523-530.
National Collaborating Centre for Acute Care (UK) (2009) Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension. National Collaborating Centre for Acute Care (UK), London.
Government of Ghana (2003) National Health Insurance Act, 2003. Ghana Publishing Company, Accra.
National Health Insurance Authority (Ghana) (2011) 2011 Annual Report.
Wittenborn, J.S. and Rein, D.B. (2011) Cost-Effectiveness of Glaucoma Interventions in Barbados and Ghana. Optometry and Vision Science Journal, 88, 155-163. https://doi.org/10.1097/OPX.0b013e3181fc30f3
World Health Organization (2015) Ghana: WHO Statistical Profile. http://www.who.int/gho/countries/gha.pdf?ua=1
Ghana Statistical Service (2014) Ghana Living Standards Survey round 6 (GLSS6): Poverty Profile in Ghana (2005-2013).
WHO. http://www.who.int/countries/gha/en/
Burr, J.M., et al. (2007) The Clinical Effectiveness and Cost-Effectiveness of Screening for Open Angle Glaucoma: A Systematic Review and Economic Evaluation. Health Technology Assessment, 11, 1-190.
Leske, M.C., et al. (2007) Predictors of Long-Term Progression in the Early Manifest Glaucoma Trial. Ophthalmology, 114, 1965-1972.
Kirwan, J.F., Nightingale, J.A., Bunce, C. and Wormald, R. (2002) Beta Blockers for Glaucoma and Excess Risk of Airways Obstruction: Population Based Cohort Study. BMJ, 325, 1396-1397. https://doi.org/10.1136/bmj.325.7377.1396
GHO. http://apps.who.int/gho/data/view.main.60630
Van Gestel, A., et al. (2010) The Relationship between Visual Field Loss in Glaucoma and Health-Related Quality-of-Life. Eye, 24, 1759-1769. https://doi.org/10.1038/eye.2010.133
Béchetoille, A., et al. (2008) Measurement of Health-Related Quality of Life with Glaucoma: Validation of the Glau-QoL 36-Item Questionnaire. Acta Ophthalmologica, 86, 71-80. https://doi.org/10.1111/j.1600-0420.2007.00999.x
Rein, D.B., Wirth, K.E., Johnson, C.A. and Lee, P.P. (2007) Estimating Quality-Adjusted Life Year Losses Associated with Visual Field Deficits using Methodological Approaches. Ophthalmic Epidemiology, 14, 258-264. https://doi.org/10.1080/01658100701473267
Brown, M.M., Brown, G.C., Sharma, S. and Landy, J. (2003) Health Care Economic Analyses and Value-Based Medicine. Survey of Ophthalmology, 48, 204-223.
Schermer, T.R., et al. (2002) Randomized Controlled Economic Evaluation of Asthma Self-Management in Primary Health Care. American Journal of Respiratory and Critical Care Medicine, 166, 1062-1072. https://doi.org/10.1164/rccm.2105116
Chen, H., et al. (2007) Asthma Control, Severity, and Quality of Life: Quantifying the Effect of Uncontrolled Disease. Journal of Allergy and Clinical Immunology, 120, 396-402.
Drummond, M.F., Torrance, G.W., O’Brien, B.J. and Stoddart, G.L. (1997) Methods for the Economic Evaluation of Health Care Programmes. 2nd Edition, Oxford University Press, Oxford.
Gold, M.R., Siegel, J.E., Russel, L.B. and Weinstein, M.C. (1996) Cost-Effectiveness in Health and Medicine. Oxford University Press, New York.
Johns, B., Baltussen, R. and Hutubessy, R. (2003) Programme Costs in the Economic Evaluation of Health Interventions. Cost Effectiveness and Resource Allocation, 1, 1. https://doi.org/10.1186/1478-7547-1-1