Cost-effectiveness of selective laser trabeculoplasty as a replacement for hypotensive eye drops in the Brazilian public health system

Abstract

Objective: This study aimed to determine the cost-effectiveness of selective laser trabeculoplasty (SLT) as a replacement for hypotensive eye drops in the Brazilian Unified Health System (SUS). Methods: The authors conducted a cost-effectiveness economic assessment using data from a previously published prospective, non-randomized, single-arm interventional study. The costs were estimated from the perspective of the SUS, using data from the SIGTAP. The authors proposed a value of R$ 588.00 for bilateral SLT, based on the observed cost reduction with medications in the SLT group. Effectiveness was assessed as a reduction in intraocular pressure (IOP). Results: The average annual cost of medications per patient was R$ 669.53 in the reference group (continuous use of eye drops) and R$ 80.62 in the intervention group (SLT). The average IOP reduction was 9.3 mmHg in the reference group and 9.8 mmHg in the intervention group. SLT proved to be a dominant strategy compared to the continuous use of eye drops, presenting a greater reduction in IOP and a lower total annual cost. The incremental cost-effectiveness ratio (ICER) was negative (-R$ 1.82), indicating that SLT is more effective and less costly. Conclusions: SLT is a cost-effective alternative to hypotensive eye drops in the treatment of glaucoma in the SUS. The adoption of SLT can optimize resource allocation and improve clinical outcomes for patients with glaucoma. Implementing SLT at the proposed procedural cost optimizes spending by substantially reducing long-term medication costs and offering a sustainable alternative within the healthcare system.