Cost-effectiveness and budget impact analysis of a patient visit support system for blindness reduction in Japanese patients with glaucoma

Figures & data

Figure 1. An overview of the model structure, used for the cost-effectiveness analysis. Glaucoma was assumed to develop from early state to blindness. In each state categorized by severity of glaucoma, treatment adherence like non-treatment was taken into account, which impacted the progression or blindness rate.

Table 1. Base case values for clinical, quality of life and cost parameters included in the study model.

Model parameters	Classifications	Base case values	References
Patient proportion
Progression	Fast	10.0%	^16
	Moderate	18.0%
	Slow	72.0%
Valuables for progression (yearly)
MD slope under treatment	Fast	0.49 dB	^24
	Moderate	0.41 dB
	Slow	0.35 dB
MD slope under non-treatment	Fast	0.82 dB	^24^,^26
	Moderate	0.68 dB
	Slow	0.58 dB
Probability to blindness (yearly)
During treatment		1.1%	^27
During non-treatment		2.2%	^27^,^28
Values for detection (yearly)
Detection rate	Early	3.7%	Japan Glaucoma Society
	Mild	10.0%	Medical specialists’ assumption
	Moderate	50.0%
	Severe	99.0%
Values for drop out (yearly)
Drop out under patient visit support system	Early	5.8%	^12
	Mild	5.8%
	Moderate	5.8%
	Severe	0.0%	Medical specialists’ assumption
Drop out under non-patient visit support system	Early	40.0%	^9
	Mild	40.0%
	Moderate	11.6%	Medical specialists’ assumption,^22
	Severe	0.0%	Medical specialists’ assumption
Utilities
Utility in each state	Early	1.00	Medical specialists’ assumption,^24^,^29^,^32
	Mild	0.99
	Moderate	0.94
	Severe	0.65
	Blindness	0.54
Cost (yearly)
Standard of care in each state	Early stage	¥40,000	Medical specialists’ assumption
	Mild	¥65,000
	Moderate	¥90,000
	Severe	¥90,000
	Blindness	¥0
Annual disability basic pension in each state	Severe	¥780,100	^30
	Blindness	¥975,125
Annual disability employee's pension in each state	Moderate	¥589,900
	Severe	¥890,000
	Blindness	¥1,060,000
Care cost		¥94,080	^7
In-kind benefit		¥139,200
Community care		¥3,827,040
Average salary		¥4,407,000	^31
Income tax		¥453,900

Abbreviations. dB, Decibel; MD, mean deviation.

Table 2. Results of the cost-effectiveness analysis.

Glaucoma patient visit support system cost per patient	¥10,000/year	¥20,000/year	¥30,000/year	¥40,000/year	¥50,000/year
Incremental costs (JPY)	428,923	628,186	827,449	1,026,713	1,225,976
Incremental QALYs	0.26
ICER (JPY/QALY)	1,680,406	2,461,067	3,241,729	4,022,390	4,803,051
Blindness reduction	8.68%
Sensitivity analysis*(Monte Carlo simulation) (%)	56.33	55.09	53.26	52.66%	51.05

Abbreviations. ICER, incremental cost-effectiveness ratio.

*The probability of this support system being cost-effective at the threshold of 5 million yen/QALY.

Figure 2. Tornado diagram showing one-way sensitivity analysis targeting ICER.

Figure 3. Monte Carlo simulation for probabilistic sensitivity analysis results.

Figure 4. Budget impact analysis results. Budget impact shows cumulative values. Difference rate depicts absolute budgetary difference rate in the particular year compared to the BI of the previous year.

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