Prm43 - A Cost-Utility Analysis of the Istent Inject Trabecular Micro-Bypass System Plus Cataract Surgery in Patients With Mild-to-Moderate Open-Angle Glaucoma in France

Abstract

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.

Systematic Literature Review of Clinical, Economic, and Humanistic Outcomes Following Minimally Invasive Glaucoma Surgery or Selective Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma with or Without Cataract Extraction

“…The higher the number of sufficient or partially reported items in the study, the higher the study quality. The included studies were rated from 27% 43 to 98% 50 demonstrating a range of quality from low to very high.…”

“…Four publications evaluated the direct costs of mild-to-moderate OAG, eg medication, outpatient visits, and hospitalization. [36][37][38][39] Eight publications assessed iStent/iStent inject, [40][41][42][43][44][45][46][47] one publication assessed both iStent inject and Hydrus, 48 one Hydrus alone, 44 and one Xen Gel Stent alone. 49 Generally, studies concluded that costs related to glaucoma management are higher in more severe disease stages 36,39 and that the economic burden impacts the healthcare system, the patient, and their family.…”

“…Additionally, there was overwhelming evidence that MIGS is cost-effective for the treatment of mild-tomoderate OAG. [40][41][42][43][44][45][46][47][48]50 Laser therapy was also considered a cost-effective option for the treatment of moderate glaucoma. 38…”