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Yvonne M. Buys, Hussain Patel, Lilach Drori Wagschal, Graham E. Trope; Economic Evaluation of ExPRESS versus Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1399.
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ExPRESS miniature glaucoma shunt is an alternative filtration procedure to trabeculectomy. The aim of this study was to compare the one year cost differences between the two operations.
Subjects enrolled in a randomized prospective study comparing ExPRESS to trabeculectomy with one year follow-up were included in the analysis. Surgical cost difference and the one year post-operative costs including follow-up visits, additional procedures and medications were determined for each subject. Costs were based on the Ontario Health Insurance Plan and the Ontario Drug Benefit Formulary. Comparisons between treatment groups were made using Wilcoxon rank-sum test for costs and chi-square for success (IOP 5-18 mmHg and 20% reduction for baseline without medication). The incremental cost-effectiveness ratio (ICER) was calculated as the ratio of mean surgical and post-operative cost differences divided by surgical success rate differences between the 2 groups at 1 year. All results are reported in Canadian dollars.
43 subjects with one year follow-up were included in the analysis (23 ExPRESS, 20 trabeculectomy). There was no statistically significant difference in success rates between the groups; 15 (65%) ExPRESS vs 11 (55%) trabeculectomy, p=0.49. The ExPRESS device had a net surgical cost of $956 greater than trabeculectomy. There was no significant difference in the overall mean post-operative cost (median [interquartile range]) between the ExPRESS ($486 [337, 822]) and trabeculectomy ($610 [305, 820], p = 0.88). There was no significant difference in cost of follow up visits ($303 [276, 358] vs $317 [276, 386], p = 0.75), additional procedures ($183 [0, 366] vs $183 [0, 366], p = 0.69) or glaucoma medication ($0 [0, 68] vs $0 [0, 91], p = 0.80) for ExPRESS vs trabeculectomy respectively. Overall, ExPRESS had a mean one year total cost of $991 greater per case than trabeculectomy. The mean ICER was $9913 per 1-year success gain.
This study demonstrates that the ExPRESS device is associated with greater surgical cost compared to trabeculectomy. For the province of Ontario if trabeculectomies were all switched to ExPRESS, the incremental cost would be $1,800,000 for the first year and for our department over $200,000.
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