advertisement
Editors Selection IGR 26-1
Surgical Treatment: Is the Hydrus Microstent cost-effective for mild-to-moderate POAG?
Comment by Ricardo Paletta Guedes on:
126559 Cost-Effectiveness Analysis of Hydrus Microstent for Patients with Mild to Moderate Primary Open-Angle Glaucoma in Canada, Ahmed IIK; Hussein I; Saheb H et al., Ophthalmology. Glaucoma, 2025; 8: 302-311
In the past years, we have seen a multitude of MIGS devices being introduced in glaucoma surgical management. Many of them have been proved effective and safe in different studies and populations.
However, there is a lack of good randomized clinical trials (RCTs), as well as cost-effectiveness data to support clinical decisions and health systems incorporations and reimbursements around the world.
The Hydrus Microstent (HMS) is one of the few devices that have been evaluated in a well-designed long-term RCT. And now, Ahmed IIk et al. present a study which aims to evaluate the cost-effectiveness of the HMS compared to cataract surgery alone (CS) for treating patients with primary open-angle glaucoma (POAG). A cost-utility analysis was used based on data from the previously published RCT, modeling a cohort of patients over a 15-year horizon, considering the perspective of the Canadian public health system payer
Main results were: • The HMS combined with CS was a dominant strategy, offering greater benefits and lower costs compared to CS alone. • Both treatments resulted in 11.41 life years, but the Hydrus + CS group gained an additional 0.311 years in QALYs (quality-adjusted life years). • Total costs were CAD 26,770 for Hydrus + CS and CAD 27,145 for CS alone, resulting in a savings of CAD 375. • Results were robust, as probabilistic sensitivity analysis indicated that 85.3% of simulations showed that Hydrus + CS was cost-effective at a willingness-to-pay threshold of CAD 50,000/QALY.
The clinical and economic implications are relevant. The use of the HMS in conjunction with cataract surgery may reduce glaucoma progression and the need for more invasive surgical interventions in the future. In addition, the analysis suggests that the combination of Hydrus + CS can improve patients' quality of life by reducing medication burden and costs associated with complications such as falls and blindness.
One should consider the limitations of this type of study, based on modelling. The model assumes linear disease progression based on medication use, which may not reflect clinical reality, where patients may alternate between different treatments. Also, costs were based primarily on data from the province of Ontario, which may not represent variations in other regions.
They conclude that the HMS, when used with cataract surgery, is a cost-effective option for treating patients with mild to moderate glaucoma, contributing to reduced disease progression and improving patient quality of life. This analysis provides additional and important economic evidence to support the use of the HMS in conjunction to CS.
Comments
The comment section on the IGR website is restricted to WGA#One members only. Please log-in through your WGA#One account to continue.Log-in through WGA#One
