Cost-effectiveness analysis of iStent trabecular micro-bypass stent for patients with open-angle glaucoma in Colombia

Abstract

Objective: To estimate the cost-effectiveness of trabecular micro bypass stent vs laser trabeculoplasty or medications only, for patients with open-angle glaucoma in a setting of the Colombian System Health.

Methods: This is a cost-effectiveness analysis that based its assumptions in external data sources, used to extrapolate the quality-of-life related to health, survival, and costs. A Markov model, with stages from 0 (ocular hypertension without glaucoma) to 5 and bilateral blindness, was developed inclusive of Colombians older than 40 years in 2018, from a societal perspective, comparing trabecular micro-bypass stents vs laser trabeculoplasty, timolol + dorzolamide + brimonidine, timolol + dorzolamide + latanoprost, or timolol + dorzolamide + brimatoprost, in terms of clinical and economic outcomes over a lifetime horizon. Both costs and health outcomes had an annual rate discount of 5%. Health outcomes were evaluated in terms of QALYs related with loss of visual acuity. Trabecular micro-bypass costs include the joint use of timolol, and the costs of laser trabeculoplasty include the combined use of timolol + dorzolamide.

Results: Trabecular micro-bypass stents were estimated to have 127,971 more discounted QALYs vs laser trabeculoplasty; 405,982 vs timolol + dorzolamide + brimonidine; and 378,287 vs timolol + dorzolamide + latanoprost or timolol + dorzolamide + brimatoprost. Cumulative costs with trabecular micro-bypass stents at 40 years was $13,252,318 lower than laser trabeculoplasty; $6,403,534, lower than timolol + dorzolamide + brimonidine; $22,311,064, lower than timolol + dorzolamide + latanoprost; and $29,156,113 lower than timolol + dorzolamide + brimatoprost.

Conclusions: The trabecular micro-bypass stent is a highly cost-saving strategy due to more QALYs related to a lower rate of the population with loss of visual acuity in the long-term, and because the costs associated with additional medications and complications are lower with trabecular micro-bypass stents.

Keywords:

• Cost-benefit analysis
• Open-angle glaucoma
• Ocular hypertension
• Stents
• Minimally invasive surgical procedures
• Medication adherence

Transparency

Declaration of funding

This research was funded by Glaukos (San Clemente, CA). The researchers declare full independence of the contract and we are solely responsible for the methods, results, and concepts raised in this paper.

Declaration of financial/other relationship

Dr Jaime E. Ordóñez receives research support from Abbvie, AstraZeneca, Biogen Idec, Bristol Myers-Squibb, CES University, Colciencias, Colombian Society of Rheumatology, Corum, Glaukos, Metrosalud, Ministry of Health and Social Protection of Colombia, Ministry of Social Welfare of Medellin, Ministry of Health of Medellin, Novo Nordisk, Stendhal, Pfizer, University of Antioquia. Dr Ordóñez is a consultant and/or on the advisory board of AstraZeneca, Bristol Myers-Squibb, Institute for the Surveillance of Medicines and Foods of Colombia (INVIMA), International Society for Pharmacoeconomics and Outcomes Research ISPOR-Colombia, Merck & Co, Ministry of Education of Colombia, Ministry of Health and Social Protection of Colombia, Novo Nordisk, Stendhal and Pfizer (Colombia and USA). Dr Ordóñez is also a speaker for Abbvie, Bayer, CES University, International Society for Pharmacoeconomics and Outcomes Research ISPOR-Colombia, Novartis, Novo Nordisk (Colombia and Panama), Stendhal and Pfizer (Colombia, Ecuador, and Dominican Republic). All other coauthors have no commercial relationship to declare. A CMRO peer reviewer on this manuscript declares honoraria, consultant, or advisory-board fees from Alcon, Allergan, Ametek, B&L, Genentech, Maculogix, OptoVue, Regeneron, SBH, Shire, Zeavision, and stock options from HPO and Zeavision. All other CMRO reviewers have no disclosures.

Acknowledgments

No assistance in the preparation of this article is to be declared.