Pharmerit International, Rotterdam, The Netherlands.
Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, Paris, France.
PLoS One. 2021 Jun 10;16(6):e0252130. doi: 10.1371/journal.pone.0252130. eCollection 2021.
To investigate the cost-effectiveness of implementing iStent inject trabecular bypass stent (TBS) in conjunction with cataract surgery (Cat Sx) in patients with mild-to-moderate glaucoma from a societal perspective in France. The secondary objective was to explore the economic impact of iStent inject TBS in patients who comply to different degrees with their anti-glaucoma medications.
A previously published Markov model was adapted to estimate the cost-effectiveness of treatment with iStent inject TBS + Cat Sx versus Cat Sx alone over a lifetime time horizon in patients with mild-to-moderate open-angle glaucoma in France. Progression was modeled by health states reflecting increasing stages of vision loss. Disease progression was obtained from the two-year randomized clinical trial assessing safety and effectiveness of both interventions. French specific health-state utilities and costs were obtained through a targeted literature review. Model structure and inputs were validated by French ophthalmologists. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY) gained. The robustness of results was tested through sensitivity analyses.
iStent inject TBS + Cat Sx reduced the number of medications needed and risk of blindness. Incremental cost and QALYs were €75 and 0.065 leading to an incremental cost-effectiveness ratio (ICER) of €1,154/QALY gained. ICER ranged from dominating for non-persistent patients to €31,127 patients fully persistent with their medication regime. Results from one-way sensitivity analysis had a maximum ICER of €29,000 when varying input parameters. iStent inject TBS + Cat Sx had an 86% chance of being cost-effective at a willingness-to-pay threshold of €30,000 per QALY gained.
Results demonstrate that iStent inject TBS + Cat Sx is a cost-effective intervention for intraocular pressure reduction when compared to Cat Sx alone in France.
从法国社会的角度出发，研究在患有轻度至中度青光眼的患者中联合白内障手术（Cat Sx）实施 iStent inject 小梁旁路支架（TBS）的成本效益。次要目的是探讨 iStent inject TBS 在不同程度遵循抗青光眼药物治疗的患者中的经济影响。
我们改编了一个先前发表的马尔可夫模型，以在法国估计 iStent inject TBS + Cat Sx 联合治疗与单独 Cat Sx 治疗轻度至中度开角型青光眼患者的终生成本效益。通过反映视力丧失程度不断增加的健康状态来模拟疾病进展。疾病进展来自评估两种干预措施安全性和有效性的两年随机临床试验。法国特定的健康状态效用和成本是通过有针对性的文献综述获得的。模型结构和输入由法国眼科医生进行了验证。结果表示为每获得一个质量调整生命年（QALY）的增量成本。通过敏感性分析测试了结果的稳健性。
iStent inject TBS + Cat Sx 减少了所需药物的数量和失明的风险。增量成本和 QALYs 分别为 75 欧元和 0.065，导致增量成本效益比（ICER）为每获得一个 QALY 的 1154 欧元。ICER 从非持续患者的主导地位到完全遵守药物治疗方案的患者为 31127 欧元不等。在对输入参数进行单向敏感性分析时，结果的最大 ICER 为 29000 欧元。当愿意支付的阈值为每获得一个 QALY 支付 30000 欧元时，iStent inject TBS + Cat Sx 有 86%的可能性具有成本效益。
结果表明，与单独的 Cat Sx 相比，iStent inject TBS + Cat Sx 在法国是一种降低眼压的具有成本效益的干预措施。
