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

Ordóñez, Jaime; Ordóñez, Angélica; Osorio, Urpy

doi:10.1080/03007995.2018.1506022

Cited by 19 publications

(26 citation statements)

References 53 publications

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“…Medication reduction lessens the financial burden of glaucoma treatment, for both patients and government bodies funding healthcare. This financial impact has been the area of several informative cost-effectiveness analyses in recent years [34][35][36][37][38][39]. The clinical outcomes in the present study are consistent with those reported in these financial evaluations.…”

Section: Discussionsupporting

confidence: 89%

“…The clinical outcomes in the present study are consistent with those reported in these financial evaluations. Thus, although this study did not analyze economic effects specifically, it is reasonable to expect that improved IOP control and a 2.43-medication reduction could result in similar benefits as those cited in these cost-effectiveness studies: for example, lower medication costs and provider expenditures, reduced societal burden from visual impairment, improved medication adherence, fewer IOP-related complications, and fewer quality-adjusted life years lost by patients because of poor vision [34][35][36][37][38][39]. Finally, topical medication usage has long been reported to cause patient-reported ocular surface discomfort and objective ocular surface damage [4,10,11,56,57], raising the possibility that decreasing usage may positively impact patients' day-to-day life.…”

Section: Discussionmentioning

confidence: 88%

“…Most studies of the device have assessed outcomes in mild to moderate glaucoma [17][18][19][20][21][22][23][24][25][26][27], but other patient populations increasingly have been the subject of evaluation, such as pseudoexfoliative glaucoma, severe or refractory glaucoma, or newly diagnosed, treatment-naïve glaucoma [28][29][30][31][32][33]. Another growing and relevant area of investigation has been economics outcomes research [34][35][36][37][38][39], which consistently has shown favorable cost-effectiveness of the iStent in various healthcare models around the world.…”

Section: Introductionmentioning

confidence: 99%

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Second-Generation Trabecular Micro-Bypass Stents as Standalone Treatment for Glaucoma: A 36-Month Prospective Study

2019

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Introduction: To evaluate long-term outcomes following stand-alone implantation of two second-generation trabecular micro-bypass stents (iStent inject Ò , Glaukos Corp., San Clemente, CA, USA) in eyes with predominantly primary open-angle glaucoma (POAG) and considerable preoperative disease burden. Methods: Eyes with POAG, pseudoexfoliative glaucoma (PXG), appositional narrow-angle glaucoma (NAG, with open-angle configuration in the area of implantation), or secondary glaucoma were included in this prospective, non-randomized, consecutive case series. All eyes underwent ab interno iStent inject implantation as a sole procedure. Assessments through 36 months included IOP, medications, corrected distance visual acuity (CDVA), secondary glaucoma surgeries, and complications and adverse events. Results: Two iStent inject stents were implanted in 44 consecutive eyes (POAG = 38, PXG = 4, appositional NAG = 1, secondary neovascular glaucoma = 1) of 31 patients, and 33 eyes had 36-month follow-up data. Preoperative mean IOP was 25.3 ± 6.0 mmHg on a mean of 2.98 ± 0.88 medications, with 75% of eyes on 3-5 medications, no eyes medication-free, and 50% of eyes with history of prior glaucoma surgery. At 36 months postoperatively, mean IOP reduced by 42% to 14.6 ± 2.0 mmHg (p \ 0.0001) and 87.9% of eyes achieved an IOP reduction of C 20% versus preoperatively. In addition, 97% of eyes reached IOP B 18 mmHg (vs. 9.1% preoperatively; p \ 0.0001) and 70.0% of eyes reached IOP B 15 mmHg (vs. 2.3% preoperatively; p \ 0.0001). Mean medication burden decreased by 82% to 0.55 ± 0.79 (p \ 0.0001), and 61% of eyes became medication-free. All eyes maintained or decreased their 36-month medication burden versus preoperatively. Safety was favorable, including minimal adverse events and stable CDVA through 36 months postoperatively. Conclusion: This real-world cohort of glaucomatous eyes with substantial preoperative disease burden experienced significant, sustained, safe IOP and medication reductions through 36 months following stand-alone iStent inject implantation. Funding: Article processing charges and writing assistance were provided by Glaukos Corp.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Second-Generation Trabecular Micro-Bypass Stents as Standalone Treatment for Glaucoma: A 36-Month Prospective Study

2019

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“…A CUA published by Stein et al [17] in 2012 studied the use of laser trabeculoplasty versus observation in the USA, estimating that trabeculoplasty was cost effective compared with observation only, with an estimated ICER of $US16,824 per QALY. Two papers compared laser trabeculoplasty and prostaglandin analogues and consistently found that laser trabeculoplasty was a less costly alternative but also presented contrasting health outcomes in terms of the most effective intervention as measured by QALYs [17,20].…”

Section: Laser Trabeculoplastymentioning

confidence: 99%

“…The study of MIGS in economic models was identified in a single article published in 2018 by Ordóñez et al [20] from a Colombian public health payer perspective. Compared with laser trabeculoplasty and three different prostaglandin analogues adjunct to timolol and dorzolamide, the micro-bypass stent with timolol was estimated to be a dominated option as it had a higher cost with a lower effectiveness in terms of QALYs [20].…”

Section: Minimally Invasive Glaucoma Surgerymentioning

confidence: 99%

Systematic Review of Economic Evaluations in Primary Open-Angle Glaucoma: Decision Analytic Modeling Insights

Bartelt-Hofer

Ben-Debba

Fleßa

2019

PharmacoEconomics Open

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Objective Our objective was to review, compare and gain insight into economic evaluations in primary open-angle glaucoma (POAG) with a focus on existing decision analytic models. Methods A literature review was performed using clinical and specialized databases following best practices. Relevant inclusion criteria included the development of a decision analytic model, the assessment of POAG interventions, and a full economic evaluation in terms of costs and health-related outcomes. Model inputs and settings were extracted, compared and analyzed. Main study incremental outcomes were also reported. Results The literature review identified 22 full articles in alignment with the eligibility criteria for a total of 15 countries and a wide range of years from 1983 to 2018. Interventions included as competing alternatives in the eligible studies were topical medications (33%), screening or diagnosis (33%), surgical interventions (10%), laser trabeculoplasty (10%) and minimally invasive surgeries (3%). Markov models using transition states were the most common type of modeling approach. Cost-utility models using a mid-to long-term time horizon with a national payer perspective were the most frequent type of economic evaluation identified. Model states commonly included disease severity levels, as defined by glaucoma staging systems, and other relevant events such as blindness and death. Authors did not sufficiently justify key modeling assumptions, inputs or the robustness of their findings. Conclusions Decision analytic models in POAG can reasonably guide future modeling research by revealing common practices, inputs and assumptions. Furthermore, this review revealed evidence gaps in terms of unexplored interventions and treatment sequences.

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Globalization of MIGS

Sng

Tham

Budenz

et al. 2020

Minimally Invasive Glaucoma Surgery

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Globalization is a comprehensive phenomenon with significant implications for global health. The globalization of minimally invasive glaucoma surgery (MIGS) is currently still a work in progress, with these devices slowly making inroads into Asia, Australasia, South America, and South Africa. Although MIGS companies can enjoy a quantum leap in economies of scale by serving global markets rather than only a confined domestic market, there are considerable economic, logistical, training, legal, and regulatory challenges that they need to overcome. The globalization of MIGS may benefit glaucoma patients worldwide, by reducing medication burden, improving the quality of life, and potentially decreasing the global incidence of glaucoma-related blindness.

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

Cited by 19 publications

References 53 publications

Second-Generation Trabecular Micro-Bypass Stents as Standalone Treatment for Glaucoma: A 36-Month Prospective Study

Second-Generation Trabecular Micro-Bypass Stents as Standalone Treatment for Glaucoma: A 36-Month Prospective Study

Systematic Review of Economic Evaluations in Primary Open-Angle Glaucoma: Decision Analytic Modeling Insights

Globalization of MIGS

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