Cost-effectiveness of Phacoemulsification versus Combined Phacotrabeculectomy for Treating Primary Angle Closure Glaucoma.

PURPOSE: To compare the cost effectiveness of phacoemulsification and combined phacotrabeculectomy for lowering intraocular pressure (IOP) in primary angle closure glaucoma (PACG) eyes with coexisting cataract.

METHODS: Real-life data of two previous randomized control trials that involved 51 medically-uncontrolled PACG eyes and 72 medically-controlled PACG eyes were utilized to calculate the direct cost of treatment. They were followed-up for two years. Cost of pre-operative assessments, surgical interventions, additional procedures for managing complications and maintenance of filtration, post-operative follow-up, and cost of medications were considered. Cost data of three different regions (The United States, People's Republic of China, and Hong Kong) were used for comparison.

RESULTS: The corresponding average costs for treating one eye with newly-diagnosed PACG by phacoemulsification alone and combined phacotrabeculectomy were US$3479 and US$2439 in the United States, US$1051 and US$861 in China, and US$6856 and US$12087 in Hong Kong. Surgical and medications costs were the two key contributors. Combined phacotrabeculectomy was more cost-effective for IOP reduction when calculating with the USA and China cost data, but was less cost-effective when calculating with the Hong Kong cost data. The cost-effectiveness was insensitive to the costs of follow-up visit and investigations, the cost of surgical operations, and the cost of post-operative procedures, but sensitive to the cost fluctuation of medications. Furthermore, for the medically-uncontrolled PACG group, phacoemulsification alone became more cost-effective when the cost of medication was reduced by more than 75%.

CONCLUSIONS: Combined phacotrabeculectomy is a more cost-effective option for lowering IOP in PACG eyes with co-existing cataract, over a 2-year follow-up period.