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  • Cost-Effectiveness of Two MIGS Stents

    By Jean Shaw
    Selected by Henry D. Jampel, MD, MHS
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    Journal Highlights

    Ophthalmology Glaucoma, May/June 2022

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    Minimally invasive glaucoma surgery (MIGS) is increasingly used to reduce IOP in glaucoma patients and is often performed concurrently with cataract surgery. Sood et al. set out to investigate the costs and effects of implanting either the Hydrus Microstent or the iStent inject during cataract surgery in the United States. They found that im­planting either device is cost-effective.

    For this cost-utility analysis, the researchers used data from published pivotal randomized controlled trials of the two devices. All study participants were 65 years and older and had mild to moderate primary open-angle glau­coma (POAG) with or without visually significant cataract. The researchers then used Markov models to simulate glaucoma progression, over a 35-year period, through four glaucoma states (mild, moderate, advanced, severe/ blind) and death in patients with a visually significant cataract. They also included a medication-only reference group to calculate total lifetime costs and outcomes for patients with mild to moderate POAG and no cataract. Main outcome measures included total costs and quality-adjusted life year (QALY). Direct medical costs were estimated at a U.S. Medicare reimbursement rate. Indirect costs included transportation and were derived from the published literature. In addition, the researchers weighted the costs to account for brand-name versus generic medication prices.

    Over 35 years in the base case, the Hydrus Microstent plus cataract sur­gery arm cost $48,026.13 and gained 12.26 QALYs; the iStent inject plus cataract surgery cost $49,599.86 and gained 12.21 QALYs; cataract surgery alone cost $54,409.25 and gained 12.04 QALYs; and initial nonsurgical man­agement cost $57,931.22 and gained 11.74 QALYs. The device arms dom­inated or were cost-effective when compared with cataract surgery alone within five years and throughout sensi­tivity analysis, the researchers said. In probabilistic sensitivity analyses, the iStent inject arm was cost-effective in 94.19% of iterations, while the Hydrus Microstent arm was cost-effective in 94.69% of iterations.

    The original article can be found here.