iStent and cataract surgery for mild-to-moderate primary open angle glaucoma in Japan: a cost-utility analysis.

AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.