Cost Utility of Schlemm’s Canal Microstent Injection with Cataract Surgery for Open Angle Glaucoma in the United States Medicare System.

Hydrus microstent implantation at the time of cataract surgery appears to be cost-effective in mild-to-moderate glaucoma. However, long-term follow-up is essential for a full assessment of device performance, safety and cost-effectiveness.
To assess the societal cost-utility to the United States Medicare system of implanting Hydrus microstent (HMS) with cataract surgery versus cataract surgery alone in patients with open angle glaucoma (OAG).
Markov model cohort of patients with mild-to-moderate OAG and visually significant cataract.
Patients received HMS during cataract surgery versus cataract surgery alone, in a deterministic model over a 2-year horizon using TreeAge software. Both arms received additional ocular hypotensive agents to control intraocular pressure (IOP). Treatment effect of HMS was measured as mean number of ocular hypotensive medications and IOP, which directly impacted transition probabilities. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. One-way sensitivity and probabilistic sensitivity analyses were conducted on device efficacy and longer time horizons.
At 2 years, HMS with cataract surgery in mild glaucoma had an incremental cost-utility ratio (ICUR) of USD 38346.43 per QALY, compared with cataract surgery alone. Probabilistic sensitivity analysis was cost-effective in 61.4% of iterations for HMS + cataract surgery. The probability of side-effects with eye drops, utility decrement with side-effects, cost of the HMS and real-world efficacy rate had the greatest impact on model outcomes. HMS must be 85.60% as effective as published data to maintain cost-effectiveness at a willingness-to-pay threshold of USD 50000. The ICUR of HMS with cataract surgery in moderate glaucoma was USD 42895.38.
Hydrus microstent implantation during cataract surgery seems to be cost-effective for patients with mild-to-moderate glaucoma. Nevertheless, more long-term safety and efficacy data are required.

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