Hydrus® Standalone Vs Istent In Patients With Advanced Poag: Cost-Effectiveness Analysis In Uk Settings
Published 2025 - 43rd Congress of the ESCRS
Reference: PP24.16 | Type: Free paper | DOI: 10.82333/w1ak-3r66
Authors: Hagay Hayat* 1 , Shawn Sapir 1 , Tzahi Sela 2 , Gur Munzer 2 , Igor Kaiserman 3
1ophthalmology department,Barzilai University Medical Center,Ashkelon,Israel, 2Care-Vision Laser Center,Tel-Aviv,Israel, 3ophthalmology department,Barzilai University Medical Center,Ashkelon,Israel;Care-Vision Laser Center,Tel-Aviv,Israel
Purpose
The 2-year COMPARE trial showed that Hydrus Microstent resulted in the use of fewer medications and a lower rate of secondary incisional glaucoma surgery when used as a standalone surgery compared to 2 iStents in patients with advanced primary open angle glaucoma (POAG). This analysis explores cost-effectiveness of Hydrus® Microstent vs iStent as standalone treatments from the UK public payer perspective.
Setting
This economic evaluation is based on UK healthcare system data, utilizing publicly available cost sources and literature.
Methods
A semi-Markov model simulated the natural history of POAG to assess patients’ costs, health outcomes, and quality-adjusted life years (QALYs) over 15 years. The population was 67 years of age, with 80% having bilateral disease. Using 2-year COMPARE data, patient progression in the model was informed by trial-based annual medication use, which was assumed to align with visual fields loss (VFL) changes. As patients progressed on medications and VFL increased, they transitioned to the next severity health state. Costs and utility weights were derived from publicly available UK sources and publications. Both deterministic and probabilistic analyses (PA) were conducted. Scenario analyses explored the impact of key inputs and assumptions.
Results
Patients who received Hydrus® experienced 6.7% fewer secondary surgical interventions than those treated with iStent over 15 years, resulting in lower costs (£26,374 vs £26,608) and greater QALYs (7.439 and 7.371), respectively. As a result, the Hydrus® is deemed a dominant treatment choice over iStent in terms of cost-effectiveness. In PA, Hydrus® had a probability of ~67% of being cost-effective compared to iStent at a willingness-to-pay threshold of £20,000/QALY.
Conclusions
As a standalone treatment for glaucoma, Hydrus® Microstent is a cost-effective treatment compared to iStent due to its superior efficacy in reducing medication use and the need for downstream invasive surgical intervention.