Igarashi Ataru, Ishida Kyoko, Shoji Nobuyuki, Chu Alice, Falvey Heather, Han Ru, Ueyama Maki, Onishi Yoshie
Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Yokohama 236-0027, Japan.
Ohashi Medical Center, Toho University, Tokyo 153-8515, Japan.
Int J Ophthalmol. 2022 Jun 18;15(6):954-961. doi: 10.18240/ijo.2022.06.13. eCollection 2022.
To evaluate the cost-utility of iStent with cataract surgery cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective.
A Markov model was adapted to estimate the cost-utility of iStent plus cataract surgery cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts.
In the probabilistic base case analysis, iStent with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent with cataract surgery cataract surgery alone was found to increase costs (¥1 025 785 ¥933 759, respectively) but was more effective in increasing QALYs (12.80 12.74) and avoiding blinded eyes (0.133 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent with cataract surgery was found to dominate cataract surgery alone.
The iStent with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.
从公共支付方的角度评估在日本环境下，iStent植入联合白内障手术与单纯白内障手术相比，用于治疗轻至中度原发性开角型青光眼（POAG）患者的成本效益。
采用马尔可夫模型，从日本公共支付方的角度，估计iStent植入联合白内障手术与单纯白内障手术相比，在轻至中度POAG患者单眼一生中的成本效益。只要有可用的日本来源数据，就用于患者特征、临床数据、效用和成本。非日本数据由日本临床专家进行验证。
在概率性基础案例分析中，当使用500万日元/质量调整生命年（QALY）的支付意愿阈值时，发现iStent植入联合白内障手术在一生中与单纯白内障手术相比具有成本效益。估计增量成本效益比（ICUR）为1430647日元/QALY获得，估计增量成本效果比（ICER）为12845154日元/避免失明眼。发现iStent植入联合白内障手术与单纯白内障手术相比增加了成本（分别为1025785日元和933759日元），但在增加QALY（12.80对12.74）和避免失明眼方面更有效（0.133对0.141）。成本差异主要由初次手术成本驱动（279903日元对121349日元）。在从社会角度进行的情景分析中，包括照顾者负担，发现iStent植入联合白内障手术优于单纯白内障手术。
从公共支付方的角度来看，iStent植入联合白内障手术是一种比单纯白内障手术更具成本效益的策略，并且从社会角度来看，在日本轻至中度POAG患者中可节省成本。
