A cost-utility analysis of the iStent inject® trabecular micro-bypass system plus cataract surgery in patients with mild-to-moderate open-angle glaucoma in France

Session Details

Session Title: Glaucoma Management

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:48

Venue: Free Paper Forum: Podium 4

First Author: : C.Schweitzer FRANCE

Co Author(s): :    A. Labbe   A. Mudd   K. Nieland   J. Kleintjens   G. Gicquel   H. Falvey              

Abstract Details

Purpose:

To estimate the cost-utility of the iStent Inject trabecular micro-bypass system plus cataract surgery (intervention) versus cataract surgery alone (comparator) from the French societal perspective.

Setting:

Bordeaux University Hospital, Bordeaux, France Quinze-Vingt Institute of Ophthalmology, Paris, France.

Methods:

A Markov model was designed to track glaucoma progression through health states using Hodapp-Parrish-Anderson stages and death over lifetime horizon. Reduction in intraocular pressure (IOP) and medication use were identified from the iStent-Inject randomized clinical trial. Transition probabilities were estimated using IOP-adjusted rate of visual field loss. A 5% decline in relative treatment effect per year was assumed for extrapolation of efficacy beyond trial follow-up. Glaucoma medication costs were estimated by MedicAM data and medication persistence using a French study. Probabilistic and one-way sensitivity analyses were conducted to estimate the impact of uncertainty on costs and quality-adjusted life years (QALYs).

Results:

An improvement in quality of life of 0.65 QALYs and an increase in costs of €529 per patient were estimated over a lifetime, leading to an incremental cost-utility ratio of €8,108. Sensitivity analyses showed the results to be relatively robust.

Conclusions:

The cost of iStent Inject is partially offset by the decreased medication costs, lower rate of secondary procedures, decreased transportation and disability costs. Together with the quality of life gains expected with iStent Inject, it is a cost-effective treatment option for patients with mild-to-moderate open-angle glaucoma in France.

Financial Disclosure:

is employed by a for profit company with an interest in the subject of the presentation