Cost-effectiveness analysis of iStent Inject® implantation during cataract surgery compared to cataract surgery alone for mild to moderate open-angle glaucoma patients in Spain

ABSTRACT

Objective

To estimate the cost-effectiveness of two trabecular micro-bypass stent implants (iStent inject®) during cataract surgery, compared to cataract surgery alone, in patients with cataracts and mild-to-moderate primary Open Angle Glaucoma (OAG) in the Spanish National Health System (SNHS).

Methods

A Markov model was used to simulate the progression of OAG patients, undergoing either cataract-iStent Inject® surgery or cataract surgery alone, over a lifetime horizon. Health states of glaucoma were based on the Hodapp-Parrish-Anderson criteria. Efficacy and resource use were obtained from published literature and validated by experts. Costs (€, 2020) were obtained from the Spanish database eSalud. The incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained was calculated. A societal perspective was also explored. Sensitivity analysis tested the robustness of results.

Results

Cataract-iStent Inject® surgery was more effective and costly than cataract surgery alone, with an ICER of 12,676.48/QALY. The probability of iStent Inject being cost-effective was 90.9% and 78.4%, at a willingness-to-pay of €30,000/QALY and €21,000/QALY, respectively. From a societal perspective, Cataract-iStent Inject® surgery was cost-saving compared to cataract surgery alone.

Conclusion

Cataract-iStent Inject® surgery was cost-effective (SNHS perspective) or cost-saving (societal perspective) compared to cataract surgery alone in patients with mild-to-moderate OAG.

KEYWORDS:

• Cost-effectiveness
• glaucoma
• iStent inject
• microinvasive glaucoma surgery
• trabecular micro-bypass

Article highlights

• Cost-effectiveness analysis of two trabecular micro-bypass stent implants (iStent inject®) during cataract surgery, compared to cataract surgery alone, in patients with cataracts and mild-to-moderate primary Open Angle Glaucoma (OAG) in the Spanish National Health System (SNHS)

• Cataract-iStent Inject® surgery was more effective and costly than cataract surgery alone, with an ICER of 12,676.48/QALY

• The probability of iStent Inject being cost-effective was 90.9% and 78.4%, at a willingness-to-pay of €30,000/QALY and €21,000/QALY, respectively.

• From a societal perspective, Cataract-iStent Inject® surgery was cost-saving compared to cataract surgery alone.

• The robustness of the results has been demonstrated through the different sensitivity analysis performed.

Declaration of interest

Miguel A Teus has acted as a consultant or received research support from the following institutions: Alcon vision LLC; Allergan; Johnson & Johnson vision; Novartis; Santen; Thea; Glaukos. Jose I Belda has acted as a consultant for Glaukos and Alcon. Cosme Lavín has acted as a consultant for Allergan, SANTEN, Ioptima, Glaukos and Thea. Julián Garcia-Feijo has acted as a consultant for the following institutions: Glaukos, Alcon, Santen, Istar, Allergan. Heather Falvey is an employee at Glaukos. Giorgio Buseghin is an employee at Glaukos. María Soler has acted as a consultant for Glaukos. Marilena Appierto has acted as a consultant for Glaukos. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Supplementary material

Supplemental data for this article can be accessed here

Author contributions

Teus MA: Conceptualization, Validation, Supervision, Writing – review & editing

Belda JI: Conceptualization, Supervision, Validation, Writing – review & editing

Lavin C: Conceptualization, Supervision, Validation, Writing – review & editing

García Feijo J: Conceptualization, Supervision, Validation, Writing – review & editing

Falvey H: Conceptualization, Supervision, Validation, Investigation, Methodology, Writing – review & editing

Buseghin G: Conceptualization, Supervision, Investigation, Methodology, Writing – review & editing

Soler M: Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing

Appierto M: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft

Additional information

Funding

The study was funded by Glaukos corporation.