ABSTRACT
Ghana ranks among the countries
most affected by glaucoma in the world. It is estimated that 700,000 people in
Ghana are affected by glaucoma, out of which 60,000 people are already blind.
In recent years, there has been a growing concern that anti-glaucoma medications
listed on the country’s health insurance medicines list are not adequate to
manage the disease. This has led to calls from different stakeholders for
prostaglandin analogues to be added to the medicines list. However, the
cost-effectiveness of this medication is yet to be established. The objective
of this study, therefore, was to establish the cost-effectiveness of
prostaglandin analogues as first-line medication for treating primary open
angle glaucoma in Ghana. A Markov Model was constructed to assess the life-time
cost-effectiveness of treating a hypothetical cohort of one thousand
55-year-old POAG patients with prostaglandin analogues compared to beta
blockers. The effect of parameter uncertainty on cost-effectiveness was
explored through one-way, two-way, and probabilistic sensitivity analyses.
Compared to beta blockers, prostaglandin analogues resulted in an incremental
cost-effectiveness ratio (ICER) of USD 11,600; based on an estimated
incremental gain of 105 quality-adjusted life years (QALYs), at an additional
cost of USD 1,222,400. The ICER was not sensitive to the age of the cohort, the
cost of prostaglandin analogues, or the probability of developing asthma.
However, the ICER was sensitive to the age of the cohort and the cost of
prostaglandin analogues when varied simultaneously. Given the existing
evidence, prostaglandin analogue is not a cost-effective alternative to beta
blockers as a first-line treatment for POAG in Ghana. The study, however, shows
that further research to reduce decision uncertainty would be necessary if
expected cost of research does not exceed USD 131 billion.