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Abstract #47839 Published in IGR 13-4
Cost-effectiveness of the ex-press glaucoma filtration device in the Netherlands
de Jong L; Lafuma A; Aguade AS; Clement O; Berdeaux GValue in Health 2011; 14: A250
OBJECTIVES: To compare the costs and effectiveness of the EX-PRESS glaucoma filtration device (Alcon Inc, TX) to trabeculectomy, 5 years after surgery, in primary open angle glaucoma (POAG). METHODS: Seventy-eight patients with POAG uncontrolled despite maximally-tolerated medical therapies were randomized to receive either the EX-PRESS or undergo a trabeculectomy, realized by a single surgeon. Outcomes captured over 5 years included intraocular pressure (IOP a surrogate endpoint of glaucoma progression), use of IOP lowering medications and additional eye surgeries. The economic perspective was the one of the Dutch National Health System. Patients were considered a success if they had an IOP less than or equal to the success thresholds of 15 or 18 mmHg, without IOP lowering medications, and without having undergone further glaucoma surgery. Time to failure was analyzed using a log rank test. Costs were discounted at a 4% rate. EX-PRESS cost was not included. RESULTS: The 5-year failure rate was 41% for EX-PRESS versus 69% for trabeculectomy (P=0.005) using an 18 mmHg IOP target and 46% versus 77% (P=0.001) for 15 mmHg. EX-PRESS patients were less likely to use medications, and among the medically treated patients, required fewer drugs. EX-PRESS eyes required less needling (2 vs 5) and less cataract surgery (5 vs. 8). Without discounting, drug savings with EX-PRESS equaled (euro)333.86 and (euro)107.79 for eye surgery /laser, a total of (euro)441.65. With a 4% discounting, the figures became (euro)310.45, (euro)132.78 and (euro)443.23, respectively. CONCLUSIONS: At 5 years after surgery, EX-PRESS demonstrated that it better controls IOP than trabeculectomy, resulting in savings in both IOP lowering drugs and eye surgeries. Economic benefits of the better IOP control (less disease progression, i.e. a better vision) and saving according to a lifelong time horizon will be estimated in future modelling exercises.
L. De jong. Amsterdam Medical Center, Amsterdam, Netherlands.
Classification:
14 Costing studies; pharmacoeconomics
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)