One-year costs of incisional glaucoma surgery and laser therapy

Abstract

Background: This study aimed to calculate one-year total costs of incisional glaucoma surgery and laser therapy in a real-world clinical setting.Methods: We conducted a retrospective cohort study from July 2010 to March 2021 using the Diagnosis Procedure Combination database. We included patients hospitalized for incisional glaucoma surgery (trabeculectomy, trabeculotomy, tube shunt surgery, Ex-PRESS surgery, or iStent implantation) or laser therapy (laser peripheral iridotomy, surgical iridectomy, laser trabeculoplasty, cyclocryotherapy, or cyclophotocoagulation).The outcomes were total costs, including costs of hospitalization, re-admissions, antiglaucoma drugs, ophthalmic examinations, and outpatient visits for incisional glaucoma surgery and laser therapy within one year.Results: We identified 49,202 eligible hospitalizations. The one-year median total cost was 707,497 yen [interquartile range: 546,887-944,664 yen]. The median total cost was the highest in patients undergoing tube shunt surgery, followed by Ex-PRESS surgery, iStent implantation, and trabeculectomy. The number and cost of postoperative outpatient visits and length of hospital stay were higher in patients who underwent trabeculectomy and Ex-PRESS surgery than in those after tube shunt surgery. The total 4 costs of laser therapies were lower than those of incisional glaucoma surgeries. The total cost was the highest in the 0-19 age group (856,398 [649,419-1,258,844] yen).Conclusions: Tube shunt surgery was the costliest in terms of total one-year costs.Trabeculectomy and Ex-PRESS surgery were associated with long hospital stays and incurred high postoperative costs. The costs of laser therapies were relatively low.However, cost-effectiveness of laser therapies compared with incisional surgeries needs to be analyzed in future research.

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

“…[ 12 ] Gamma 10% Trabeculectomy 697 008 (±20%) Ref. [ 17 ] Gamma 10% Discount rate, % 2.0 (0.0–4.0) Ref. [ 16 ] NA NA LPI laser peripheral iridotomy, PACS primary angle-closure suspect, PAC primary angle closure, PACG primary angle-closure glaucoma, AACC acute angle-closure crisis, JPY Japanese Yen, QALY quality-adjusted life-year, NA not applicable.…”

“…The annual cost of the drugs used in the treatment of PACG was obtained from a cost analysis study conducted in Japan [ 15 ]. The costs of trabeculectomy and 1-year postoperative treatment were obtained from another cost analysis study conducted in Japan [ 17 ]. The one-year treatment cost for each health state was inferred from clinical practice based on the guidelines for glaucoma treatment in Japan (Supplementary Table 2 ) [ 12 ].…”