OBJECTIVE: To assess the efficiency of alternative monitoring services for @entity1 with @entity2790 ( @entity2790 ), a @entity726 risk factor. DESIGN: Discrete event simulation model comparing five alternative care pathways: treatment at @entity2790 diagnosis with minimal monitoring; biennial monitoring (primary and secondary care) with treatment if baseline predicted 5-year @entity726 risk is >= 6%; monitoring and treatment aligned to National Institute for Health and Care Excellence (NICE) @entity726 guidance (conservative and intensive). SETTING: UK health services perspective. @entity1 : Simulated cohort of 10   000 adults with @entity2790 (mean intraocular pressure (IOP) 24.9   mm   Hg (SD 2.4). MAIN OUTCOME MEASURES: Costs, @entity726 detected, quality-adjusted life years (QALYs). RESULTS: Treating at diagnosis was the least costly and least effective in avoiding @entity726 and progression. Intensive monitoring following NICE guidance was the most costly and effective. However, considering a wider cost-utility perspective, biennial monitoring was less costly and provided more QALYs than NICE pathways, but was unlikely to be cost-effective compared with treating at diagnosis (  86   717 per additional QALY gained). The findings were robust to risk thresholds for initiating monitoring but were sensitive to treatment threshold, National Health Service costs and treatment adherence. CONCLUSIONS: For confirmed @entity2790 , @entity726 monitoring more frequently than every 2   years is unlikely to be efficient. Primary treatment and minimal monitoring (assessing treatment responsiveness (IOP)) could be considered; however, further data to refine @entity726 risk prediction models and value @entity1 preferences for treatment are needed. Consideration to innovative and affordable service redesign focused on treatment responsiveness rather than more @entity726 testing is recommended.

Monitoring XXXX , how much and how often? A cost-effectiveness perspective.

@entity1 :: ('9606', 'Species') :: ['patient', 'PARTICIPANTS', 'people'] @entity2790 :: ('MESH:D009798', 'Disease') :: ['OHT', 'ocular hypertension'] @entity726 :: ('MESH:D005901', 'Disease') :: ['glaucoma']
@entity2790 :: (MESH:D009798,Disease) :: ['ocular hypertension']
