Objective To investigate the cost-effectiveness of implementing iStent inject trabecular bypass stent (TBS) in conjunction with cataract surgery (Cat Sx) in patients with mild-to-moderate glaucoma from a societal perspective in France. The secondary objective was to explore the economic impact of iStent inject TBS in patients who comply to different degrees with their anti-glaucoma medications. Methods A previously published Markov model was adapted to estimate the cost-effectiveness of treatment with iStent inject TBS + Cat Sx versus Cat Sx alone over a lifetime time horizon in patients with mild-to-moderate open-angle glaucoma in France. Progression was modeled by health states reflecting increasing stages of vision loss. Disease progression was obtained from the two-year randomized clinical trial assessing safety and effectiveness of both interventions. French specific health-state utilities and costs were obtained through a targeted literature review. Model structure and inputs were validated by French ophthalmologists. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY) gained. The robustness of results was tested through sensitivity analyses. Results iStent inject TBS + Cat Sx reduced the number of medications needed and risk of blindness. Incremental cost and QALYs were €75 and 0.065 leading to an incremental cost-effectiveness ratio (ICER) of €1,154/QALY gained. ICER ranged from dominating for non-persistent patients to €31,127 patients fully persistent with their medication regime. Results from one-way sensitivity analysis had a maximum ICER of €29,000 when varying input parameters. iStent inject TBS + Cat Sx had an 86% chance of being cost-effective at a willingness-to-pay threshold of €30,000 per QALY gained. Conclusion Results demonstrate that iStent inject TBS + Cat Sx is a cost-effective intervention for intraocular pressure reduction when compared to Cat Sx alone in France.

periprosthetic joint infection. Probabilistic sensitivity analysis examined the effect of combined uncertainty across model parameters. RESULTS: Comparing DM to LFH, incremental costs over 3 years were £428 vs. £1,447 in the UK, V451 vs. V1,272 in Germany, V540 vs. V1,425 in Italy, and V523 vs. V1,562 in Spain (95% CI). DM implants were cost saving for patients undergoing revision THA at a cost differential of £1,019 in the UK, V820 in Germany, V885 in Italy, and V1,039 in Spain. CONCLUSIONS: A model using clinical data derived from a large-sample registry, healthcare costs using country-specific procedural reimbursement codes and tariffs, and probabilistic sensitivity analysis within a Markov decision-analytic model provided a novel and reproducible analytic method to assess the costs of DM vs. LFH in revision THAs. OBJECTIVES:Many countries have a national Health Technology Assessment (HTA) body that makes decisions/recommendations on publically reimbursing new healthcare technologies. For some, a key criterion is cost-effectiveness based upon their cost per Quality Adjusted Life Year (QALY) in relation to willingness to pay (WTP) thresholds. This research aims to identify, compare and evaluate WTP thresholds across countries. METHODS: Publically-available HTA guidelines were screened for 35 countries across Europe, Asia-Pacific, and the Americas for key criteria for decision-making and WTP thresholds. RESULTS: 20 countries spanning five continents were identified where cost/QALY was a key decision-making criterion encompassing both developed (e.g. England and Sweden) and emerging markets (e.g. Thailand and Colombia). 17/35 (49%) countries had explicit WTP threshold or threshold ranges, with the lowest in Thailand (160,000THB [V4,200]), and the highest in Sweden, where the upper-most threshold range reaches V90,000. Five countries link the WTP threshold to a multiple of GDP/capita (Brazil, Columbia, Czech Republic, Mexico, Poland). 6/35 (17%) countries had ICER thresholds that varied depending on the severity/burden of disease and/or the level of unmet need (Norway, Sweden, Netherlands, England, Australia, Colombia). An additional 4/35 (11%) markets (England, Australia, Netherlands, and Sweden) had specific decision-modifiers enabling eligible therapies to be considered at higher WTP thresholds (e.g. England: HST for ultra-orphan indications [£100,000-£300,000/QALY; V113,900-V341,700/QALY] and End of Life criteria [not stated]). CONCLUSIONS: The WTP for a QALY can vary substantially between as well as within countries. The WHO recommends a WTP of <3 times GDP per capita/QALY, which few countries follow. If other markets adopted this WHO standard it would substantially increase their WTP thresholds. From a utilitarian perspective, WTP should be consistent across diseases. Another perspective is that WTP should reflect the opportunity cost; new interventions with higher budget impacts should have lower WTP thresholds, supporting higher WTP for orphan diseases.

Objectives: Recent epidemiological and cost analyses show statistically significant associations between hypotension during ICU stay with death, acute kidney injury (AKI) and hospital costs at MAP levels below 65mmHg. This analysis estimates the associated cost savings per ICU patient that accrue to US hospitals as a result of improved hypotension control between MAP of 65 mmHg and 85 mmHg. Methods: In our economic analysis we estimated patient-level costs associated with hypotension reduction in septic ICU patients from the hospital perspective. The reduction in the probabilities of AKI and death were sourced from a prior EMR (Electronic Medical Records) analysis in which hypotension exposure was defined by timeweighted average mean arterial pressure (TWA-MAP). Our analysis focused on TWA-MAP levels between 65-85 mmHg. Cost savings for each of the separate outcomes in sepsis was estimated from the current published literature. All dollars were adjusted to reflect 2018 costs. Scenario analyses and Monte Carlo simulations were performed to test the robustness of the model. We also developed a second model as a robustness check. Results: For our main model, we ran two simulations (10,000 trials each). These models compared expected cost difference in A) 65 vs. 75 TWA-MPA mmHg and B) 75 vs. 85 TWA-MAP mmHg hypothetical patients. Cost savings were A