Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
Devers Eye Institute, Legacy Research Institute, Portland, OR.
J Glaucoma. 2023 Mar 1;32(3):145-150. doi: 10.1097/IJG.0000000000002143. Epub 2023 Feb 1.
The cost of cyclophotocoagulation is less than the cost of a second glaucoma drainage device.
To compare the total direct costs of implantation of a second glaucoma drainage device (SGDD) with transscleral cyclophotocoagulation (CPC) for patients with inadequately controlled intraocular pressure (IOP) reduction, despite the presence of a preexisting glaucoma drainage device in the ASSISTS clinical trial.
We compared the total direct cost per patient, including the initial study procedure, medications, additional procedures, and clinic visits during the study period. The relative costs for each procedure during the 90-day global period and the entire study period were compared. The cost of the procedure, including facility fees and anesthesia costs, were determined using the 2021 Medicare fee schedule. Average wholesale prices for self-administered medications were obtained from AmerisourceBergen.com. The Wilcoxon rank sum test was used to compare costs between procedures.
Forty-two eyes of 42 participants were randomized to SGDD (n=22) or CPC (n=20). One CPC eye was lost to follow-up after initial treatment and was excluded. The mean (±SD, median) duration of follow-up was 17.1 (±12.8, 11.7) months and 20.3 (±11.4, 15.1) months for SGDD and CPC, respectively ( P =0.42, 2 sample t test). The mean total direct costs (±SD, median) per patient during the study period were $8790 (±$3421, $6805 for the SGDD group) and $4090 (±$1424, $3566) for the CPC group ( P <0.001). Similarly, the global period cost was higher in the SGDD group than in the CPC group [$6173 (±$830, $5861) vs. $2569 (±$652, $2628); P <0.001]. The monthly cost after the 90-day global period was $215 (±$314, $100) for SGDD and $103 (±$74, $86) for CPC ( P =0.31). The cost of IOP-lowering medications was not significantly different between groups during the global period ( P =0.19) or after the global period ( P =0.23).
The total direct cost in the SGDD group was more than double that in the CPC group, driven largely by the cost of the study procedure. The costs of IOP-lowering medications were not significantly different between groups. When considering treatment options for patients with a failed primary GDD, clinicians should be aware of differences in costs between these treatment strategies.
环光凝的成本低于第二个青光眼引流装置的成本。
比较 ASSISTS 临床试验中，对于眼压（IOP）控制不佳的患者，在存在先前青光眼引流装置的情况下，植入第二个青光眼引流装置（SGDD）与经巩膜环光凝（CPC）的总直接成本。
我们比较了每位患者的总直接成本，包括初始研究程序、药物、附加程序和研究期间的就诊次数。比较了 90 天全球期间和整个研究期间每个程序的相对成本。使用 2021 年医疗保险费用表确定程序的费用，包括设施费用和麻醉费用。从 AmerisourceBergen.com 获取自我管理药物的平均批发价格。使用 Wilcoxon 秩和检验比较程序之间的成本。
42 名参与者的 42 只眼被随机分配到 SGDD（n=22）或 CPC（n=20）组。CPC 组的一只眼在初始治疗后失访，被排除在外。SGDD 和 CPC 组的平均（±SD，中位数）随访时间分别为 17.1（±12.8，11.7）个月和 20.3（±11.4，15.1）个月（P=0.42，2 样本 t 检验）。SGDD 组和 CPC 组在研究期间的每位患者的总直接成本（±SD，中位数）分别为 8790 美元（±3421 美元，6805 美元）和 4090 美元（±1424 美元，3566 美元）（P<0.001）。同样，SGDD 组的全球期间成本高于 CPC 组[$6173（±830，5861）与$2569（±652，2628）；P<0.001]。90 天全球期后，SGDD 组的每月费用为 215 美元（±314 美元，100 美元），CPC 组为 103 美元（±74 美元，86 美元）（P=0.31）。在全球期间（P=0.19）或全球期间后（P=0.23），两组之间的降眼压药物成本没有显著差异。
SGDD 组的总直接成本是 CPC 组的两倍多，主要由研究程序的成本驱动。两组之间的降眼压药物成本没有显著差异。当考虑失败的原发性 GDD 患者的治疗选择时，临床医生应注意这些治疗策略之间的成本差异。
