Synopsis Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research. Background/aims Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy. Methods A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained. Results Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study. Conclusion This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon. Data are available upon reasonable request. Data will be available beginning 10 months and ending four years after publication of this paper. Data will be available for researchers who provide a methodologically sound scientific proposal, which has been approved by an ethics committee. Proof of the latter should be provided. Analyses should achieve the aims reported in the approved proposal. Requests for data sharing should be made to the corresponding author at ashleigh.kernohan@newcastle.ac.uk.

中文翻译：

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初次手术与初次内科治疗治疗晚期青光眼患者的成本效益


概要 晚期青光眼与视力丧失有关。这项试验内的经济评估比较了医疗和手术管理策略。两年后，尽管纵向结果是未来研究的重要课题，但药物治疗似乎更具成本效益。背景/目标 开角型青光眼 (OAG) 是一种进行性视神经病变。大约 25% 的新诊断 OAG 患者至少一只眼睛患有晚期疾病。与 OAG 相关的视力丧失可能会对视力、生活质量和医疗保健资源产生重大影响。晚期青光眼治疗研究是一项随机对照试验，比较初级手术和药物治疗对新诊断的晚期 OAG 患者的有效性。进行了经济评估，以了解每种策略的成本和收益。方法 从国家卫生服务体系的角度进行了 2 年时间范围内的成本效用分析，其中包括患者费用。主要结局是通过 EQ-5D-5L、健康效用指数 3 (HUI3) 和青光眼效用指数 (GUI) 衡量的患者健康相关生活质量。结果表示为每获得 QALY 的增量成本。结果 小梁切除术与较高的成本和较大的效果相关，EQ-5D-5L 结果的每个 QALY 的增量成本为 45,456 英镑。在 20 英镑、000 英镑、30,000 英镑和 50,000 英镑 QALY 阈值下，手术具有成本效益的可能性分别为 0%、12% 和 56%。 HUI3、GUI 和包含患者费用的结果不会改变研究的结论。结论 这是第一项评估晚期青光眼患者治疗策略的研究。 从两年的时间来看，药物治疗是治疗青光眼更具成本效益的方法。未来的研究可以集中于较长时间范围内治疗的成本和效益。数据可根据合理要求提供。数据将于本文发表后 10 个月至四年内提供。数据将提供给提供方法上合理的科学提案并已得到伦理委员会批准的研究人员。应提供后者的证明。分析应实现已批准提案中报告的目标。数据共享请求应通过 ashleigh.kernohan@newcastle.ac.uk 向通讯作者提出。