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Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

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Autor(a) principal: Guedes,Ricardo Augusto Paletta
Data de Publicação: 2012
Outros Autores: Guedes,Vanessa Maria Paletta, Chaoubah,Alfredo
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos brasileiros de oftalmologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492012000100002
Resumo: PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).
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spelling Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)Glaucoma/economyFiltering surgery/economyHealth care costsCost-effectiveness evaluationPURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).Conselho Brasileiro de Oftalmologia2012-02-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492012000100002Arquivos Brasileiros de Oftalmologia v.75 n.1 2012reponame:Arquivos brasileiros de oftalmologia (Online)instname:Conselho Brasileiro de Oftalmologia (CBO)instacron:CBO10.1590/S0004-27492012000100002info:eu-repo/semantics/openAccessGuedes,Ricardo Augusto PalettaGuedes,Vanessa Maria PalettaChaoubah,Alfredoeng2012-04-27T00:00:00Zoai:scielo:S0004-27492012000100002Revistahttp://aboonline.org.br/https://old.scielo.br/oai/scielo-oai.phpaboonline@cbo.com.br||abo@cbo.com.br1678-29250004-2749opendoar:2012-04-27T00:00Arquivos brasileiros de oftalmologia (Online) - Conselho Brasileiro de Oftalmologia (CBO)false
dc.title.none.fl_str_mv Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
title Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
spellingShingle Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
Guedes,Ricardo Augusto Paletta
Glaucoma/economy
Filtering surgery/economy
Health care costs
Cost-effectiveness evaluation
title_short Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
title_full Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
title_fullStr Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
title_full_unstemmed Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
title_sort Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)
author Guedes,Ricardo Augusto Paletta
author_facet Guedes,Ricardo Augusto Paletta
Guedes,Vanessa Maria Paletta
Chaoubah,Alfredo
author_role author
author2 Guedes,Vanessa Maria Paletta
Chaoubah,Alfredo
author2_role author
author
dc.contributor.author.fl_str_mv Guedes,Ricardo Augusto Paletta
Guedes,Vanessa Maria Paletta
Chaoubah,Alfredo
dc.subject.por.fl_str_mv Glaucoma/economy
Filtering surgery/economy
Health care costs
Cost-effectiveness evaluation
topic Glaucoma/economy
Filtering surgery/economy
Health care costs
Cost-effectiveness evaluation
description PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).
publishDate 2012
dc.date.none.fl_str_mv 2012-02-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492012000100002
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492012000100002
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/S0004-27492012000100002
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Conselho Brasileiro de Oftalmologia
publisher.none.fl_str_mv Conselho Brasileiro de Oftalmologia
dc.source.none.fl_str_mv Arquivos Brasileiros de Oftalmologia v.75 n.1 2012
reponame:Arquivos brasileiros de oftalmologia (Online)
instname:Conselho Brasileiro de Oftalmologia (CBO)
instacron:CBO
instname_str Conselho Brasileiro de Oftalmologia (CBO)
instacron_str CBO
institution CBO
reponame_str Arquivos brasileiros de oftalmologia (Online)
collection Arquivos brasileiros de oftalmologia (Online)
repository.name.fl_str_mv Arquivos brasileiros de oftalmologia (Online) - Conselho Brasileiro de Oftalmologia (CBO)
repository.mail.fl_str_mv aboonline@cbo.com.br||abo@cbo.com.br
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