• Cost-Effectiveness of Intracameral Moxifloxacin

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    Journal of Cataract & Refractive Surgery
    2018;44(8):971-978

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    Using recent data and different payer perspectives, Leung et al. compared adjuvant intracameral (IC) moxifloxa­cin plus perioperative topical antibiotic treatment against standard prophy­laxis (i.e., topical antibiotics) to assess cost-effectiveness for endophthalmitis prevention after cataract surgery. They found that, despite the rising cost of IC moxifloxacin, the drug can be cost-effective as well as cost-saving from the U.S. societal perspective. However, from the standpoint of the health care sector, the drug was cost-effective but not cost-saving.

    The researchers calculated incre­mental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) for 2 groups of patients: 1) Those who received standard prophy­laxis and 2) those who received standard prophylaxis plus IC moxifloxacin. The base case was a healthy 73-year-old man with bilateral cataracts undergo­ing uncomplicated first-eye surgery. Incidence and cost data were derived from results of a PubMed search in addition to Medicare reimbursement rates and average wholesale drug prices. All costs and benefits were adjusted by 3% annually and for inflation. To assess uncertainty, the authors performed deterministic and probabilistic sensitiv­ity analyses.

    Their results showed that, compared with standard prophylaxis, an adjuvant 500 μg of IC moxifloxacin (for $20) was cost-saving from a societal stand­point in the base case. In probabilistic sensitivity analyses, all values were within the societal willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY). Of 10,000 iterations, 6,142 (61%) were cost-saving. Although IC moxifloxacin at this price point was cost-effective from the health care sector perspective (ICUR of $8,275 per QALY), it was cost-saving only in cases with posterior capsule tear. Adjuvant IC moxifloxacin was superior to topical antibiotics for improving QALYs.

    According to this study, the price tag for 500 μg of IC moxifloxacin would need to be less than $22.20 to achieve societal cost-saving and less than $9.20 for health care sector cost-saving.

    The original article can be found here.