Focus on Glaucoma

SLT: An economical choice for early glaucoma

Evidence shows lasers are a cost-effective option for patients and practices.

By E. Randy Craven, MD

About the Author
	E. Randy Craven, MD, is chief of glaucoma at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia Disclosure: Dr. Craven is a consultant to Allergan, Ivantis and Transcend Medical.

Glaucoma is one of the leading causes of blindness worldwide. In 2010 it was estimated to have affected more than 60 million patients around the globe, with the number of affected patients set to rise considerably in coming years as the world population ages.¹

In the United States alone, approximately 2.7 million people have glaucoma.² This large patient population subsequently implies a heavy economic burden of treatment.

Selective laser trabeculoplasty (SLT) is poised as an effective therapy for glaucoma that also reduces the overall treatment costs by reducing patients’ dependence on medications.

ADVANTAGES OVER MEDICATIONS

Cost savings short- and long-term

When comparing the total cost for generic eye drops such as latanoprost and timolol with SLT, we reach the break-even point at 13 and 40 months, respectively.³

Similarly, a 2012 study compared the cost of laser trabeculoplasty (LTP) to prostaglandin analogs in the treatment of newly diagnosed open angle glaucoma.⁴ Using a Markov Model to estimate incremental cost effectiveness over a 25-year period, the authors found that LTP provided a cost saving of $2,645 per quality adjusted life year compared to PGAs.

The true savings are likely to be much higher because this model assumed 75% of patients comply with their medication regimen, a rather optimistic estimate.

SLT treatments, which selectively target pigmented cells, can be more cost-effective than medications.

Multi-drug patients

Most glaucoma patients use two or three drugs to control their IOP. For such patients, SLT can provide an even greater savings. A study from Dr. Cindy Hutnik’s group at Western University in London, Ont., found that SLT could provide six-year cumulative cost reduction of $206 vs. monotherapy, $1,666 vs. two-drug therapy and $2,992 vs. three-drug treatments, even if patients need a repeat SLT at two years after the initial treatment.⁵

A doctor helps align a patient seated in front of an SLT laser in preparation of the procedure.
COURTESY: LUMENIS

The cost benefits are even greater when patients do not need repeat SLT for three years after the initial treatment. Additionally, SLT also abates the compliance issues surrounding the use of drops, killing two birds with one stone.

ADVANTAGES OVER SURGERY

Filtering procedures

The favorable economics of SLT also measure up when compared to surgery. An Indiana University study found that the five-year cumulative cost of SLT was considerably less than filtering surgery — $4,838 for SLT vs. $6,571 for medications and $6,363 for surgery.⁶

The order of treatments given can also have an impact on costs, according to an economic study from the Centre for Eye Research Australia.⁷ This study found that first-line SLT therapy followed by medications and then trabeculectomy was cost-effective, returning $2.50 for every $1 spent. This was true even if the cost of SLT treatment increased fourfold. In such a case, the Australian investigators found the return on investment was $1.74 for each dollar spent.⁷

Financial benefits for ophthalmologists

Besides reducing costs to the patient, SLT may also alleviate the cost of glaucoma treatment that ophthalmologists incur. Because SLT can be more economical than medications, third-party payers might favor ophthalmologists who perform SLT as more attractive providers than those who prescribe two or three medications.

Understanding whether acquiring a laser will provide a return on investment, however, will require a financial analysis. Four key factors to consider:

• Patient volume. A higher volume of patients will mean performing the procedure more often, which will directly economize the investment required to acquire a laser.

• Patient/payer mix. Whether patients have Medicare or a commercial insurer will also impact the return on their investment; different payers reimburse different amounts.

• Where the procedure is performed. Performing the procedure at the office instead of an ambulatory service center (ASC) can also affect the revenue from SLT. Although payers generally reimburse ASC procedures less than in-office procedures, performing SLT in an ASC may make more financial sense because the ASC partners share the up-front cost of acquiring the laser. This is especially practical with low patient volumes.

• When the procedure is performed. Whether SLT is performed during the same visit as patient consultation or is scheduled on a separate day affects revenue, as some payers may reimburse less for a same-day procedure.

Controlling costs with SLT

SLT is changing the landscape of glaucoma therapy. Not only is it a safe and highly effective approach as first-line glaucoma therapy, as adjunctive therapy with medications and as alternative therapy when medications or surgery fail, but it is also a more economical option and promises to reduce the long-term costs of glaucoma treatment for patients, ophthalmologists and the health-care system alike. OM

REFERENCES