Objective: This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG). Method: This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital. Results: Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT. Conclusion In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.
Economic analysis ; cost-utility ; glaucoma ; prostaglandin analogues ; quality adjusted life years ; Philippines

OBJECTIVE: To describe the demographic and clinical characteristics of patients with glaucoma managed at private and government institutions in the Philippines between 2009 and 2014.

METHODS: A research team from two private and two government institutions in the Philippines reviewed the case records of 1246 patients seen who met the following criteria: intraocular pressure of >21 mmHg, optic nerve and nerve fiber layer abnormalities, and visual field defects. For bilateral cases, we selected the eye with worse glaucoma parameters.

RESULTS: There were 600 and 646 patients in the private and government groups (mean age at presentation, 60.51 and 55.88 years), respectively, with the majority being Filipino (91%). Patients with visual acuity (VA) of 20/20 to 20/40 were more frequently observed in private centers (58.7% vs. 41.3%), while a VA worse than counting fingers was more frequently observed in government centers (66.1% vs. 33.9%). Within-group analysis showed that primary angle-closure glaucoma was the most frequent glaucoma subtype in both private (27.3%) and government institutions (37.8%). In between-group analysis showed the following to be more common in private than government centers: primary open-angle glaucoma (61.3% vs. 38.7%), normal-tension glaucoma (63.9% vs. 36.1%), ocular hypertension (92.3% vs. 7.7%), and glaucoma suspects (80.4% vs. 19.6%) while government institutions registered a larger number of primary angle-closure glaucoma (59.8% vs. 40.2%) and secondary glaucoma (70.3% vs. 29.7%) cases. Medical treatment using a single drug and multiple drugs was employed for 245 (23%) and 825 (77%) patients, respectively. Within-group analysis showed that laser iridotomy and trabeculectomy were the most commonly performed laser and surgical procedures in both institution types.

CONCLUSION: There is a contrasting profile of glaucoma between clinical institutions in the Philippines with openangle glaucoma being more predominant in private centers while closed-angle glaucoma and secondary glaucoma being more frequent in government centers. Our findings may provide important preliminary information that can aid future health studies or training programs.

Human ; Glaucoma ; Patients