OBJECTIVES: Glaucoma is a chronic ophthalmic disease related to significant clinical, social and economic burden for the patients and society as a whole. The study assessed the cost-effectiveness of therapies included in therapeutic guidelines for glaucoma patients in the Republic of North Macedonia.

METHODS: Cost-utility analysis was performed from the healthcare perspective. The analysis was based on real-world data for 236 glaucoma patients in 2020. The costs within a year for each alternative (laser, surgical or pharmacotherapy) were evaluated on the basis of top-down approach. Costs for laser and surgical procedure were paid only once per patient and no subsequent pharmacotherapy was needed. Data for quality of life came from EQ-5D-5L questionnaire as Quality-adjusted life years (QALYs) were calculated for 1-year. Cost–utility was expressed in incremental cost-effectiveness ratio. Cost-effectiveness planes and Tornado diagrams were generated to illustrate the cost-effectiveness of treating glaucoma with the available approaches.

RESULTS: Mean annual cost per patient and QALYs values in the group on medication therapy were 239.11 € (SD = 4.54) and 0.77 (SD = 0.14), 22.50 € and 0.52 (SD = 0.11) for laser therapy and 562.50 € and 0.55 (SD = 0.06) for surgery, respectively. Pharmacotherapy (beta-blockers, carbonic anhydrase inhibitors) was dominant over surgical therapy as it was associated with lower costs and a higher value for QALYs (Ϫc = - 323.39 € and ϪQALY = 0.22). Surgical therapy compared to laser therapy led to higher costs and greater QALYs as the incremental ratio of 15,329.78 € was higher than 3-times gross domestic product per capita for the Republic of North Macedonia (14,617.95 € in 2020). One-way sensitivity analysis showed that in all cases pharmacotherapy remained dominant alternative except decreasing QALYs with 30%.

CONCLUSIONS: This real-world evidence demonstrates the cost-effectiveness of pharmacotherapy for glaucoma in the Republic of North Macedonia.