TUESDAY, Jan. 28, 2003 (HealthDayNews) -- The cost of treatment to prevent the flare-up of a common eye condition -- a seemingly smart medical move -- actually comes with a hefty price tag, a new study says.
Researchers in Texas looked at the cost of preventing flare-ups of Herpes Simplex Virus (HSV) Eye Disease, a condition that affects more than 400,000 Americans. While treating the virus once it occurs is approximately $290, averting a flare-up by treating the patient with the drug acyclovir digs much deeper into the pocketbook.
One year of treatment with the antiviral costs $8,532, the researchers report in the January issue of the Archives of Ophthalmology.
"The drug was effective, but not cost-effective," says study co-author Charles Begley, a professor in the School of Public Health at the University of Texas Health Science Center.
Ocular HSV is one of the leading causes of blindness, and mainly affects the cornea, which is the clear layer of the eye. While researchers aren't sure how the virus is transmitted, most people have the virus in a latent form until something triggers an outbreak, Begley says. The affected eye becomes red, and blurred vision may occur. There are estimated to be 59,000 new and recurrent episodes of ocular HSV each year in the United States.
The researchers analyzed data of a clinical trial of 703 people with ocular HSV. Half of participants were treated with a placebo and half were given twice daily doses of 400 milligrams of oral acyclovir for a year. Using this data, the scientists used an economic "decision-tree" model to determine the costs of treating people to prevent flare-ups.
"It's a common analysis that economists use that allows specific consequences of decisions," Begley says.
The researchers included the average price around the country to treat a flare-up, including medication and physician services. They factored in savings from fewer infections and surgeries that were avoided.
They also considered that taking acyclovir daily could not guarantee a person would not experience a flare-up. Of the people on acyclovir in the trial, 19 percent had a flare-up in the year of follow-up. In the placebo group, 32 percent did.
Finally, the researchers looked at whether the treatment would be cost-effective for a specific group of people, those with stromal keratitis, a type of ocular HSV that often leads to more serious vision problems, including blindness. "The cost of drugs was (still) too high," Begley says.
Begley says he's fairly sure that most individuals and insurers would balk at paying more than $8,000 annually to avert recurring problems. "We don't know, but we think it's just common sense. Would you be willing to pay $8,500 for a 50 percent reduction for the average person?" he asks.
There are limited health-care dollars and many places to spend them, notes Dr. Mark Fendrick, an associate professor at the University of Michigan's School of Public Health.
"There's tremendous growth to show whether medical interventions provide benefits or not," he says. "We have to make decisions as to what to invest our resources in. We can't give everything to everybody."
More people might think the price worth it if the researchers were "trying to prevent a rare, rapidly progressing mortal disease," Fendrick adds.
If drugs became more efficient at treating or curing ocular HSV, the cost might not seem so high, he says. On the other hand, if it were determined that wearing sunglasses could reduce the risk of recurrence, then the cost to use acyclovir would seem even higher than it does, Fendrick says.
At this time, the study "shows us that it seems somewhat expensive to prevent this disease," he says.
Fendrick says it's important to do these types of studies to show what is cost-effective, and to help officials decide where to spend their health-care dollars. However, "I'm glad I'm not the one making those decisions," he says.
More information
To read the new study, visit this American Medical Association site. For more on ocular HSV, visit Emory University.
