ESCRS - P185 - COSTS AND EFFICACY OF COMBINED ISTENT INJECT W AND PHACOEMULSIFICATION IN GERMANY

COSTS AND EFFICACY OF COMBINED ISTENT INJECT W AND PHACOEMULSIFICATION IN GERMANY

Published 2024 - 28th ESCRS Winter Meeting

Reference: P185 | Type: Submission | DOI: 10.82333/51bt-m974

Authors: Matthias Fritz Uhrmann* 1 , Tilman Littan 1

1AUGEN LOHR MVZ,Lohr,Germany

Purpose

To evaluate the costs and efficacy of combined phacoemulsification and iStent inject w trabecular bypass implant in a real-world setting in Germany.

Setting

We followed an interventional case series with 223 eyes of 196 patients (51% male). Diagnoses enclosed mild-to moderate open angle, pigmentary and pseudoexfoliative glaucoma.

Methods

Efficacy outcomes were glaucoma medication reduction and intraocular pressure 4 weeks after surgery. For the estimation of costs, we set up an individual patient sampling model in Python 3.12.0 programming language and simulated 100000 patients over a lifetime’s horizon. In 2-state Markov model and a Monte-Carlo approach, age, mortality rate and medications before and after the intervention were implemented. Cycle length was 0,33 years. Direct costs of the iStent w procedure and savings due to the discontinuation of topical medication were calculated.

Results

Before combined phacoemulsification and iStent inject w trabecular bypass procedure, carbonic anhydrase inhibitors were used in 109 eyes, beta blockers in 103 eyes, alpha-2-agonists in 65 eyes and prostaglandins in 176 eyes. After the intervention, carbonic anhydrase inhibitors were used in 72 eyes (-34%), beta blockers in 54 eyes (-48%), alpha-2-agonists in 40 eyes (-62%) and prostaglandins in 82 eyes (-53%). Mean intraocular pressure was 18,0 mmHg (SD 3,9) before and 14,8 mmHg (SD 3,9) after surgery. Direct costs of the iStent inject procedure accrued to €1288,81 including german value-added tax. Total direct costs over a patient’s lifetime with the iStent w procedure were €3907,94 vs. €4686,72 without. In a sensitivity analysis, model’s robustness was demonstrated.

Conclusion

Despite high initial costs, iStent inject combined with phacoemulsification can lower glaucoma treatment costs from a patient’s lifetime perspective. It proves to be a cost-effective way for mild-to-moderate open angle glaucoma in a real-world setting in Germany.