A budget-impact analysis of the iStent inject® trabecular micro-bypass system vs trabeculectomy for the treatment of glaucoma from a German payer perspective

Session Details

Session Title: Presented Poster Session: Glaucoma I

Venue: Poster Village: Pod 3

First Author: : H.Falvey USA

Co Author(s): :    A. Buchholz   P. Buchholz   S. Bluemle   C. Steeds              

Abstract Details

Purpose:

In Germany, moderate to severe glaucoma patients who are uncontrolled or unsuitable for medical or laser therapy have traditionally undergone trabeculectomy (TRAB). In recent years, iStent inject trabecular micro-bypass system (iStent inject) which creates a bypass through the trabecular meshwork, has become available for use in conjunction with or without cataract surgery in patients with POAG, pseudoexfoliative glaucoma, and pigmentary glaucoma.

Setting:

A model was developed to estimate the cost per patient treated with iStent inject, compared to TRAB, and the impact on the German statutory health insurance (SHI) budget.

Methods:

A budget impact model was developed in MS Excel® calculating the cost of managing patients with the stent (in- or outpatient) over 3-years, as well as TRAB (inpatient only). For the stent cohort, costs were analysed for implantation with and without cataract surgery. TRAB interventions rates were derived from data published by the German Society of Ophthalmology.  Inpatient (DRG) and outpatient (EBM) tariffs were obtained from official sources. Direct costs including the intervention, glaucoma medications and reoperation rates were obtained from published clinical data. Other direct medical costs were expected to be equivalent for both options. Sensitivity analyses were conducted

Results:

Over 3-years, cumulative reoperation rates and percent of patients using IOP lowering medications were 8.1% and 20% for the stent and 13% and 41% for TRAB, respectively. The 3-year total inpatient costs per patient for the stent was €3486 both as a stand-alone procedure or in combination with cataract, and the 3-year outpatient costs (approximately 60% of patients) were €1929 and €2051 respectively.  Costs for TRAB, which is only performed as an inpatient procedure, amounted to €3789. The estimated total 3 years cost to the German SHI was 27.8 million€ for the stent and 44.1 million€ for TRAB.

Conclusions:

iStent inject is a cost-saving treatment option compared with TRAB in the treatment of glaucoma in Germany over a 3 year period.   Additionally, increasing the use of the stent in the outpatient setting and in combination with cataract surgery has the potential to reduce costs further.

Financial Disclosure:

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