Custo-utilidade do tratamento primário não farmacológico do glaucoma primário de ângulo aberto no sistema público de saúde brasileiro

Abstract

Glaucoma is a genetic and chronic disease, defined as a typical optic neuropathy that results in functional and structural damage. Primary open-angle glaucoma is the most prevalent type of glaucoma, and treatments aim at controlling intraocular pressure, either by surgery, medication or laser. There are factors that can cause failure in clinical treatment, such as drugs´ excessive cost and side effects. As a consequence of the increase in life expectancy of the Brazilian population, the incidence of glaucoma tends to rise significantly, generating an increase in its economic impact on the expenses of patients, health systems and society as a whole. The objective of the study is to evaluate the economic impact of initiating the treatment of POAG with nonpharmacological strategies within the reference centers for the treatment of glaucoma by the SUS. Three treatment strategies were studied: the first follows the usual SUS therapy; strategies 2 and 3 have the same treatment initiation, using SLT laser, but what differs them is the therapeutic option after SLT. The Markov model was chosen based on the characteristics of the pathology under study, as it is a chronic disease with recurrent and growing costs, using the incremental cost-utility ratio (ICUR) as an outcome measure, in which the incremental cost per benefit is achieved (R$/QALY). Strategies 2 and 3 generated a gain in quality of life, and were dominant over strategy 1, being more effective and cheaper. However, the cost-effectiveness of strategy 2 suffers a significant impact according to the age of entry into the model. Therefore, we conclude that when starting the treatment of initial POAG with SLT, there is a gain in quality of life and a reduction in future costs in relation to the usual treatment with eye drops. The use of the trabecular device after laser failure generates an even greater gain in quality of life, and its cost, although higher, can be considered cost-effective from the perspective of SUS.