Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma

Abstract

Aim: Patients with open-angle glaucoma (OAG) whose intraocular pressure is not adequately controlled by one medication have several treatment options in the US. This analysis evaluated direct costs of unilateral eye treatment with two trabecular micro-bypass stents (two iStents) compared to selective laser trabeculoplasty (SLT) or medications only.

Materials and methods: A population-based, annual state-transition, probabilistic, cost-of-care model was used to assess OAG-related costs over 5 years. Patients were modeled to initiate treatment in year zero with two iStents, SLT, or medications only. In years 1–5, patients could remain on initial treatment or move to another treatment option(s), or filtration surgery. Treatment strategy change probabilities were identified by a clinician panel. Direct costs were included for drugs, procedures, and complications.

Results: The projected average cumulative cost at 5 years was lower in the two-stent treatment arm ($4,420) compared to the SLT arm ($4,730) or medications-only arm ($6,217). Initial year-zero costs were higher with two iStents ($2,810) than with SLT ($842) or medications only ($996). Average marginal annual costs in years 1–5 were $322 for two iStents, $777 for SLT, and $1,044 for medications only. The cumulative cost differences between two iStents vs SLT or medications only decreased over time, with breakeven by 5 or 3 years post-initiation, respectively. By year 5, cumulative savings with two iStents over SLT or medications only was $309 or $1,797, respectively.

Limitations: This analysis relies on clinical expert panel opinion and would benefit from real-world evidence on use of multiple procedures and treatment switching after two-stent treatment, SLT, or polypharmaceutical initial approaches.

Conclusions: Despite higher costs in year zero, annual costs thereafter were lowest in the two-stent treatment arm. Two-stent treatment may reduce OAG-related health resource use, leading to direct savings, especially over medications only or at longer time horizons.

Keywords:

• Glaucoma
• iStent
• stent
• trabeculoplasty
• surgery
• medication
• intraocular pressure
• cost
• economics
• health economics

Transparency

Declaration of funding

Research funding for this study was provided by Glaukos Corporation (Laguna Hills, CA).

Declaration of financial/other interests

JPB discloses consulting and lecture fees from Glaukos. AKK discloses being a speaker for Neomedix; trainer for Glaukos and Neomedix; receiving research support from Glaukos, Transcend Medical, Iridex, and InnFocus; and consulting for Iridex. LJK discloses speaker honoraria, stock, and being an employee and SAB member for Glaukos. LH discloses research support and consulting with Glaukos, SAB member for Sight Sciences, and Glaucoma Advisory Board member for Alcon. AJL and TMY are employees of Quorum Consulting, Inc. MJB is an employee of Glaukos. LBC discloses research support, consulting, and travel support from Allergan, research support from Valeant and InnFocus, and ownership interest in Mati Therapeutics. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

The authors would like to thank Heather Falvey for her assistance with writing and editing of the manuscript, and Jason Moore for his assistance with building the model structure.

Previous presentation

This analysis was previously presented as a poster at the 2016 Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research.