Optimal surveillance regimes for individuals with OHT modelling

Optimal surveillance regimes for individuals with ocular hypertension (OHT): modelling and economic evaluation

Ocular hypertension (OHT) (raised intra-ocular pressure (IOP) >21mmHg) is one of the major risk factors for developing glaucoma, and one of the main causes of blindness in the UK. It is also the only risk factor that can be treated. Treatment, usually in the form of eye drops, reduces the risk of progressive disease. However, the dilemma is that OHT is much more common than glaucoma, and not everybody with OHT will develop glaucoma. Monitoring people with OHT to determine the need for IOP-lowering treatment needs to be proportionate to the risk of developing glaucoma and associated sight loss. This study determined effective and efficient monitoring strategies for OHT through identification and validation of glaucoma-risk prediction models and economic decision analytic modelling. In addition to the standard cost–utility analysis (CUA), population preferences were elicited for attributes of alternative monitoring strategies and applied in the decision model in the form of a cost–benefit analysis (CBA).

Outcome and Translation

This study provided evidence on the most clinical and cost-effective way to monitor individuals with OHT in the UK. It also highlighted the potential importance of public preferences for broader measures of value, with the preferred strategy based on the CBA findings being different to the recommended approach based on findings of the CUA. Based on the evidence provided by this study, NICE have decided to review the glaucoma clinical guidelines in 2016, with a view to reporting in 2017.

This project also acted as the case study for Rodolfo Hernández's PhD project.

HERU Researchers involved in this research project: Rodolfo Hernández , Mandy Ryan and Luke Vale (HERU/HSRU)

External Collaborators: A Azuara-Blanco, J Cook, (HSRU, University of Aberdeen); J Burr (University of St. Andrews); J Deeks (University of Birmingham); DF Garway-Heath, R Wormald (Moorfields Eye Hospital NHS Foundation Trust); D Crabb (City University); R Perera, A Kotecha, P Glasziou (University of Oxford)

Publications

Burr, J.M., Botello-Pinzon, P., Takwoingi, Y., Hernández, R., Vazquez-Montes, M., Elders, A., Asaoka, R., Banister, K., van der Schoot, J., Fraser, C., King, A., Lemij, H., Sanders, R., Vernon, S., Tuulonen, A., Kotecha, A., Glasziou, P., Garway-Heath, D., Crabb, D., Vale, L., Azuara-Blanco, A., Perera, R., Ryan, M., Deeks, J. and Cook, J. (2011) Surveillance for ocular hypertension: an evidence synthesis and economic evaluation. Final report submitted to NIHR HTA Programme (project number 07/46/02), Health Technology Assessment.

Burr, J.M., Botello-Pinzon, P., Takwoingi, Y., Hernandez, R., Vazquez-Montes, M., Elders, A., Asaoka, R., Banister, K., van der Schoot, J., Fraser, C., King, A., Lemij, H., Sanders, R., Vernon, S., Tuulonen, A., Kotecha, A., Glasziou, P., Garway-Heath, D., Crabb, D., Vale, L., Azuara-Blanco, A., Perera, R., Ryan, M., Deeks, J. and Cook, J. (2012) 'Surveillance for ocular hypertension: an evidence synthesis and economic evaluation', Health Technology Assessment, 16(29).

Hernández, R., Burr, J.M., Vale, L., Azuara-Blanco, A., Cook, J.A., Banister, K., Tuulonen, A. and Ryan, M. (2016) ‘Monitoring ocular hypertension, how much and how often? A cost-effectiveness perspective,’ British Journal of Ophthalmology, 100, 1263-1268.

Hernández, R., Burr, J.M., Vale, L., Azuara-Blanco, A., Cook, J.A., Banister, K., Tuulonen, A., Ryan, M. and Surveillance of Ocular Hypertension Study Group (2016.) 'Treatment or monitoring for people with ocular hypertension?', HERU Policy Brief, University of Aberdeen, May 2016.

 

Presentations

Hernández, R., Vale, L., Ryan, M., Burr J., for the Surveillance of Ocular Hypertension Project group. (2011) 'Incorporating results from a discrete choice experiment into a discrete event simulation model: the case of monitoring individuals with ocular hypertension' [Poster], 8th Annual Meeting of Health Technology Assessment International Society, Rio de Janeiro, Brazil, 26 – 29 June 2011.

Hernández, R., Vale, L., Ryan, M. and Burr, J. M. (2014) 'Incorporating results from a discrete choice experiment into a discrete event simulation model', 1st Meeting of the International Academy of Health Preference Research, Amsterdam, 8 November 2014.

Hernández, R., Vale, L., Ryan, M. and Burr, J.M. (2017) 'Broadening the valuation space in HTA: the case of monitoring individuals with ocular hypertension', International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 20th Annual Congress, Scottish Event Campus, Glasgow, 4-8 November 2017.