Cost-effectiveness of medications compared with laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma

Arch Ophthalmol. 2012 Apr;130(4):497-505. doi: 10.1001/archophthalmol.2011.2727. Epub 2012 Feb 13.


Objective: To determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP).

Methods: Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only.

Results: The incremental cost-effectiveness of LTP over no treatment is $16,824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14,179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value.

Conclusions: Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / economics*
  • Cloprostenol / administration & dosage
  • Cloprostenol / analogs & derivatives*
  • Cloprostenol / economics
  • Cost-Benefit Analysis
  • Glaucoma, Open-Angle / diagnosis
  • Glaucoma, Open-Angle / economics*
  • Glaucoma, Open-Angle / therapy
  • Health Status
  • Humans
  • Laser Therapy / economics*
  • Markov Chains
  • Medication Adherence
  • Middle Aged
  • Quality of Life
  • Quality-Adjusted Life Years
  • Trabeculectomy / economics*
  • Travoprost


  • Antihypertensive Agents
  • Cloprostenol
  • Travoprost