A cost-effectiveness analysis of iStent inject combined with phacoemulsification cataract surgery in patients with mild-to-moderate open-angle glaucoma in France.

Kaspar Nieland,Antoine Labbé,Maarten Treur,Cedric Schweitzer,Gaetan Gicquel,Heather Falvey,Joris Kleintjens,Amrita Ostawal,Aparna Rao

doi:10.1371/journal.pone.0252130

Abstract

ObjectiveTo investigate the cost-effectiveness of implementing iStent inject trabecular bypass stent (TBS) in conjunction with cataract surgery (Cat Sx) in patients with mild-to-moderate glaucoma from a societal perspective in France. The secondary objective was to explore the economic impact of iStent inject TBS in patients who comply to different degrees with their anti-glaucoma medications.MethodsA previously published Markov model was adapted to estimate the cost-effectiveness of treatment with iStent inject TBS + Cat Sx versus Cat Sx alone over a lifetime time horizon in patients with mild-to-moderate open-angle glaucoma in France. Progression was modeled by health states reflecting increasing stages of vision loss. Disease progression was obtained from the two-year randomized clinical trial assessing safety and effectiveness of both interventions. French specific health-state utilities and costs were obtained through a targeted literature review. Model structure and inputs were validated by French ophthalmologists. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY) gained. The robustness of results was tested through sensitivity analyses.ResultsiStent inject TBS + Cat Sx reduced the number of medications needed and risk of blindness. Incremental cost and QALYs were €75 and 0.065 leading to an incremental cost-effectiveness ratio (ICER) of €1,154/QALY gained. ICER ranged from dominating for non-persistent patients to €31,127 patients fully persistent with their medication regime. Results from one-way sensitivity analysis had a maximum ICER of €29,000 when varying input parameters. iStent inject TBS + Cat Sx had an 86% chance of being cost-effective at a willingness-to-pay threshold of €30,000 per QALY gained.ConclusionResults demonstrate that iStent inject TBS + Cat Sx is a cost-effective intervention for intraocular pressure reduction when compared to Cat Sx alone in France.

Highlights

Glaucoma is a neurodegenerative disease that is characterized by progressive, and largely asymptomatic vision loss caused by optic nerve damage, and is the second leading cause of irreversible blindness worldwide [1,2,3,4]
Results iStent inject trabecular bypass stent (TBS) + Cat Sx reduced the number of medications needed and risk of blindness
Results demonstrate that iStent inject TBS + Cat Sx is a cost-effective intervention for intraocular pressure reduction when compared to Cat Sx alone in France

Summary

Introduction

Glaucoma is a neurodegenerative disease that is characterized by progressive, and largely asymptomatic vision loss caused by optic nerve damage, and is the second leading cause of irreversible blindness worldwide [1,2,3,4]. A retrospective study in France revealed that only 45% of patients are persistent to first-line therapy with medications after one year [8]. Poor persistence can be due to the asymptomatic symptoms of glaucoma, which makes the patient not realize the importance of medication. Another reason for poor persistence is that medication can cause frequent adverse reactions like corneal erosion and superficial punctate keratitis, and aggravate the ocular surface disease (OSD) that often coexists with glaucoma [9,10,11]. Last, filtering surgery, effective, is only recommended when other forms of therapy have failed, due to the invasive nature of filtering surgery and the associated long-term risks such as the development of persistent corneal edema and dysesthesia [14, 15]

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