The following is a summary of “Cost-utility analysis of prophylactic laser peripheral iridotomy for primary angle closure suspects,” published in the April 2024 issue of Ophthalmology by Rothman et al.
Researchers conducted a retrospective study assessing the cost-effectiveness of preventive laser peripheral iridotomy (LPI) for individuals with primary angle closure (PAC) suspects (PACS).
They used a Markov model to compare LPI versus observation in PACS eyes over 40 one-year cycles (100,000 iterations per strategy). In each cycle, eyes progressed through PAC stages based on literature-derived transition rates, including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Acute angle closure advanced to PAC or PAC glaucoma (PACG). Perimetric reduction tracked PACG progression. The researchers also aimed for an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life years.
The results showed that, at age 50, LPI saved money with ZAP data and was affordable with ANA-LIS data. At 55, ZAP made it worthwhile from the society’s view, and at 70, from a third-party view. By reaching 80, LPI was no longer cost-effective from the societal perspective, and by 85, it was not with ZAP data or from a third-party view with ANA-LIS. Probabilistic analysis favored LPI until age 85.
Investigators concluded that Prophylactic LPI is cost-effective for various age groups and should be considered from a public health perspective.
Source: ajo.com/article/S0002-9394(24)00151-X/abstract
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