Table 2.

Model Inputs.

Parameter	Value	References
Effectiveness: Proportion who were medication-adherent 6 mos after randomization
Intervention	78%	15
Standard of care (control group)	40%	15
Costs
Intervention and standard of care costs
Intervention	$526	15
Standard of care (control group)	$28	15
Office Visits and Procedures
Level IV Office Visit, New Patient (CPT 99204)	$169.98	47
Gonioscopy (CPT 92020)	$28.33	47
Pachymetry (CPT 76514)	$11.60	47
Visual Field Testing (CPT 92083)	$65.60	47
Fundus Photography (CPT 92250)	$128.88	47
Optical Coherence Tomography (CPT 92134)	$338.30	47
Level IV Office Visit, Return Patient (CPT 99214)	$132.90	47
Level III Office Visit, Return Patient (CPT 99213)	$81.33	47
Low Vision Services, New Patient (CPT 99205)	$212.31	47
Occupational Therapy, Initial Evaluation (CPT 97166)	$321.18	47
Occupational Therapy Home Visits (CPT 97530 & CPT 97535)	$75.92	47
Trabeculectomy with Anti-metabolite (CPT 66170)	$1157.44	47
Trabeculectomy Revision (CPT 66185)	Not available, assumed same as above based on equal facility charges	48
Tube Shunt Implant with graft (CPT 66180)	$3523.36	47
Laser Trabeculoplasty (CPT 65855)	$348.37	47
Facility Fees for Glaucoma Surgery		48
Laser Trabeculoplasty (CPT 65855)	$2793.70	48
Trabeculectomy (CPT 66170, 66185)	$8075.24	48
Tube Shunt Implant (CPT 66180)	$14 650.17	47
Treatment of complications from trabeculectomy, tube shunt implant, or laser trabeculoplasty (CPT 66250)	$841.94	47
Medication Costs
Latanoprost 2.5 mL	$1.49	49
Timolol 0.5% 10 mL	$11.90	49
Brimonidine 0.2% 10 mL	$1.46	49
Dorzolamide 2% 10 mL	$3.99	49
Moxifloxacin 3 mL	$8.50	49
Prednisolone 10 mL × 2 bottles	$26.94	49
Ketorolac tromethamine 0.5% 5 mL × 2 bottles	$9.50	49
Atropine 2 mL	$15.40	49
Additional Low Vision Care Costs
Low Vision Rehabilitation for those with ≥1 Eye Blind	$1969/yr	35, 36
Utilities
Mild Glaucoma	0.92	50, 51
Moderate Glaucoma	0.89	50, 51
Severe Glaucoma	0.86	50, 51
Single-Eye Blindness	0.47	52
Bilateral Blindness	0.26	52
CPT = current procedural terminology.