Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma

Ashleigh Kernohan* (Corresponding Author), Tara Homer, Hosein Shabaninejad, Anthony J King, Jemma Hudson, Gordon Fernie, Augusto Azuara-Blanco, Jennifer Burr, John M Sparrow, David Garway-Heath, Keith Barton, John Norrie, Graeme Maclennan, Luke Vale

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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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.

Original languageEnglish
Pages (from-to)1452-1457
Number of pages6
JournalBritish Journal of Ophthalmology
Issue number10
Early online date26 Jul 2022
Publication statusPublished - 1 Oct 2023

Bibliographical note

Funding This work was supported by the National Institute for Health Research Health Technology Assessment Programme, grant number [12/35/38].

Data Availability Statement

Data availability statement
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


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