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Budget impact analysis of the iStent inject® implant for open-angle glaucoma treatment in Spain

Poster Details

First Author: J.Belda SPAIN

Co Author(s):    K. Schargel   M. Teus   C. Lavin   M. Soler   M. Appierto        

Abstract Details


Micro invasive glaucoma surgery (MIGS) devices are a valid alternative to control intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). Implantation of the trabecular Micro-Bypass Stent, iStent Inject®, has demonstrated its efficacy and safety in patients with mild-to-moderate OAG, efficiently reducing IOP and medication use, both as a standalone procedure and as a combined procedure at the time of cataract surgery. In this light, the objective of this study was to evaluate the financial consequences of using iStent Inject® to achieve IOP control, in patients with mild-to-moderate OAG undergoing cataract surgery.


The analysis was carried out from the Spanish National Health System (NHS) perspective. Thus, only direct medical costs were considered.


A budget impact model was developed to estimate the 3-years economic implications of implanting iStent inject® during combined glaucoma-cataract surgery. The current scenario (all patients undergoing MIGS receive XEN®) was compared with three alternative scenarios considering a low, medium and high penetration of iStent Inject®, respectively. Device costs, costs associated to surgical procedures, patients’ follow-up and adverse events (AEs) management were considered (€,2018). Costs were obtained from a national database. The study population, resource use and AEs frequency were estimated based on published literature and validated by Spanish expert ophthalmologists. Uncertainty was assessed through scenario and one-way sensitivity analyses.


Over 3 years, the cost of OAG management in the current scenario was estimated at € 55,033,953. The inclusion of iStent inject® substantially reduced OAG management costs, resulting in savings between € 1,647,776 (low penetration) and € 3,128,413 (high penetration). The analysis showed that the device cost for iStent Inject® was more than offset by savings in surgical procedure, patients’ follow-up and AEs management. Consistent with its favorable safety profile, the sensitivity analyses indicated that iStent inject® would still produce savings when assuming the same follow-up and surgical time requirements as for XEN®, confirming the robustness of the results.


The results of the analysis indicate that, compared to the current scenario (use of XEN® as the only MIGS device), the introduction of iStent inject® for combined glaucoma-cataract surgery, in mild-to-moderate OAG, would deliver substantial savings for the Spanish NHS.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... receives consulting fees, retainer, or contract payments from a competing company

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