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Abstract #100748 Published in IGR 23-1
Comparative cost-effectiveness of trabeculectomy versus MicroShunt in the United States Medicare system
Atik A; Fahy E; Rhodes LA; Samuels BC; Mennemeyer ST; Girkin CAOphthalmology 2022; 129: 1142-1151
PURPOSE: To assess the societal cost-utility of MicroShunt compared with trabeculectomy for the surgical management of glaucoma in the United States Medicare system. DESIGN: Cost-utility analysis using efficacy and safety results of a randomized controlled trial and other pivotal clinical trials. SUBJECTS: Markov model cohort of patients with open angle glaucoma METHODS: Open angle glaucoma treatment costs and effects were analysed with a deterministic model over a 1-year horizon using TreeAge software. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. Both treatment arms received additional ocular hypotensive agents to control intraocular pressure (IOP). Treatment effect was measured as mean number of ocular hypotensive medications and reduction in IOP, which had a direct impact on transition probabilities between health states. Scenarios analyses were performed with longer time horizons. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the impact of alternative model inputs. Both treatment arms were subject to reported complication rates, which were factored in the model. MAIN OUTCOME MEASURES: Incremental cost per QALY gained RESULTS: At 1 year, MicroShunt had an expected cost of USD 6318 compared with USD 4260 for trabeculectomy. MicroShunt patients gained 0.85 QALYs, compared with 0.86 QALYs for trabeculectomy, resulting in a dominated incremental cost-utility ratio of USD-187,680. Dominance is a health economic term used to describe a treatment option which is both more costly and less effective than the alternative. MicroShunt remained dominated in one-way sensitivity analyses using best-case input parameters (including a device fee of USD0). At a willingness-to-pay threshold of USD50000, the likelihood of MicroShunt being cost-effective was 6.4%. Dominance continued in longer time horizons, up to 20 years. CONCLUSION: Trabeculectomy appears to be a dominant treatment strategy over MicroShunt in the surgical management of glaucoma. More independent, long-term studies are required for MicroShunt and other subconjunctival microstent devices to evaluate their use in clinical practice.
Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham (UAB) Callahan Eye Hospital, Birmingham, AL, United States.
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