Manchester iStent study: 3-year results and cost analysis

Abstract

Purpose To evaluate the safety, efficacy, and the cost of combined phacoemulsification and single iStent insertion in open angle glaucoma (OAG) at 3-years follow-up. Methods This was a prospective, uncontrolled, interventional case series. All subjects underwent single iStent implantation combined with cataract surgery by a single surgeon and were followed up over 3 years. Primary outcome measures were the reduction in intraocular pressure (IOP) and number of glaucoma drops at 1, 2, and 3 years. The costs of the procedure vs the cost of continuation of glaucoma drops were calculated and compared in patients who completed 3-years follow-up. Results Forty-one patients were included in the study and thirty-six patients completed 3-years follow-up. Mean pre-op IOP was 21.2 mm Hg on 2.1 medications. Mean IOP was reduced to 15.9 mm Hg on 0.5 drops, 16.1 mm Hg on 1.0 drops, and 17.1 mm Hg (Po0.001) on 1.3 drops (Po0.001) at 1, 2, and 3 years, respectively. The overall cost of combined cataract surgery and iStent was estimated to be £829.32 more in total than conservative management with brand name eye drops over 3 years (£7.70 per patient per year) and £14 176.9 more if generic drops were used. (£131.3 per patient per year). Conclusions Combined phaco-iStent proved to be a safe and effective way of managing patients with OAG over our 3-year follow-up period. The cost-effectiveness of the procedure may vary depending on whether brand name or generic eye drops are used.

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

“…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.…”

“…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.…”

“…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.…”

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

“…Medications are effective and reasonably safe, and they usually are the first step in treating glaucoma patients. However, medications can be associated with substantial side effects [2][3][4], ocular surface damage [5][6][7], financial costs [8][9][10][11][12][13][14], and limited effectiveness due to nonadherence in an estimated 30-80% of patients [15,16]. Laser trabeculoplasty is modestly effective in reducing IOP, but its effectiveness wanes over time [17].…”

One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management

“…Studies have shown that these stents have the potential to safely lower IOP to the 15-20 mm Hg range in open-angle glaucoma patients. [2][3][4][5] Where a lower IOP may be required due to advanced glaucomatous change, these stents may not be the intervention of choice. The suprachoroidal stents, Cypass (Transcend Medical, Menlo Park, CA, USA) and iStent Supra (Glaukos Corporation), provide direct communication between the AC and suprachoroidal space.…”