Comparative Cost-effectiveness of the Baerveldt Implant, Trabeculectomy With Mitomycin, and Medical Treatment

Abstract

IMPORTANCEThe Tube vs Trabeculectomy Trial (TVT) found that the 350-mm 2 Baerveldt implant (tube) and trabeculectomy with mitomycin may be similarly effective in lowering intraocular pressure in primary open-angle glaucoma. However, to date, there are no published long-term clinical data on the cost-effectiveness of trabeculectomy with mitomycin vs tube insertion.OBJECTIVE To assess the cost-effectiveness of these procedures compared with maximal medical treatment. DESIGN, SETTING, AND PARTICIPANTSWe used the Markov cohort model with a 5-year time horizon to study a hypothetical cohort of 100 000 patients who required glaucoma surgery. MAIN OUTCOMES AND MEASURESQuality-adjusted life-years (QALYs) gained, costs from the societal perspective, and the incremental cost-effectiveness ratio of medical treatment, trabeculectomy, and tube insertion. Costs were identified from Medicare Current Procedural Terminology and Ambulatory Payment Classification reimbursement codes and Red Book medication costs. The QALYs were based on visual field and visual acuity outcomes. The hypothetical societal limit to resources was included using a willingness-to-pay threshold of $50 000 per QALY. Costs and utilities were discounted at 3% per year. Uncertainty was assessed using deterministic sensitivity analyses.

Rapid learning curve assessment in an ex vivo training system for microincisional glaucoma surgery

“…MIGS have a favorable risk profile and appropriate effectiveness for a spectrum of glaucoma types either as an initial 4, 20, 21 , or as a secondary procedure 6 , and across a range of severity 22, 23 . This suggests that MIGS surgeons may play an increasing role in reducing the economic burden of glaucoma by providing an earlier and less expensive intervention 24, 25 than traditional glaucoma surgeries 26 .…”

Is it Time to Overthrow Trabeculectomy as an Initial Surgical Procedure for Non High Risk Open Angle Glaucomas?

“…Cost is another important point. According to Kaplan et al, the mean costs for trabeculectomy, and tube insertion were $7872 and $10075, respectively with a cost difference of $2203 (95% CI, $2121-$2261) [17].…”

Evidence-based medicine in glaucoma surgery

“…In such cases, the changes in cost effectiveness can be simulated using a probabilistic sensitivity analysis. In the study by Kaplan et al,22 the authors concluded that trabeculectomy was more likely to be preferred at lower WTP values.…”

“…Kaplan et al22 assessed the cost effectiveness of trabeculectomy with MMC and Baerveldt implant and compared them with the maximal medical treatment according to the results of the TVT Study. The mean costs for medical treatment, trabeculectomy, and Baerveldt implantation were US $6172, US $7872, and US $10,075, respectively.…”