For a study, researchers sought to compare the societal cost-utility of implanting Hydrus microstent (HMS) with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma. Patients with mild-to-moderate open-angle glaucoma and visually significant cataract were studied using a Markov model cohort. Patients received HMS during cataract surgery versus cataract surgery alone in a deterministic model over a 2-year horizon using TreeAge software. To control intraocular pressure, both arms received additional ocular hypotensive agents. The treatment effect of HMS was measured by the mean number of ocular hypotensive medications and intraocular pressure, both of which directly impacted transition probabilities. The Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death were among the health states. On-device efficacy and longer time horizons, one-way and probabilistic sensitivity analyses were performed. Compared to cataract surgery alone, HMS with cataract surgery had an incremental cost-utility ratio of USD 38,346.43 per utility gained at 2 years. For HMS+cataract surgery, probabilistic sensitivity analysis was cost-effective in 61.4% iterations. The likelihood of side effects with eye drops, utility decrement with side effects, HMS cost, and real-world efficacy rate had the greatest influence on model outcomes. To maintain cost-effectiveness at a willingness-to-pay threshold of USD 50,000, HMS must be 85.60% as effective as published data. The incremental cost-utility ratio of HMS versus cataract surgery in moderate glaucoma was USD 42,895.38. HMS implantation during cataract surgery appeared to be cost-effective for patients with mild-to-moderate glaucoma. However, more long-term safety and efficacy data were needed.
