Abstract
Purpose :
In Germany, moderate to severe glaucoma patients who are uncontrolled or unsuitable for medical or laser therapy have traditionally undergone trabeculectomy (TRAB). In recent years, the ab interno stent, which creates a bypass through the trabecular meshwork, has become available for mild to moderate patients to treat earlier stage glaucoma. A model was developed to estimate the cost per patient treated with the stent, compared to TRAB, and the impact on the German statutory health insurance (SHI) budget.
Methods :
A budget impact model was developed in MS Excel® calculating the cost of managing patients with the stent (in- or outpatient) over a 3-year period, as well as TRAB (inpatient only). For the stent cohort, costs were analysed for implantation as a stand-alone procedure and in combination with cataract surgery. The total population eligible for stent treatment was estimated from a report on the care situation for glaucoma patients in Germany (IBES). The number of TRAB interventions was derived from data published by the German Society of Ophthalmology. Cost data on inpatient (DRG) and outpatient (EBM) tariffs were obtained from official sources. Direct costs including the intervention, additional glaucoma medications and reoperation rates were obtained from published clinical data. Other direct medical costs were expected to be equivalent for both options. Sensitivity analyses were conducted.
Results :
Over 3-years, cumulative reoperation rates and percent of patients using IOP lowering medications were 8.1% and 20% for the stent and 13% and 41% for TRAB, respectively. The 3-year total inpatient costs per patient for the stent was €3486 both as a stand-alone procedure or in combination with cataract, and the 3-year outpatient costs (appr. 60% of patients) were €1929 and €2051 respectively. Costs for TRAB, which is only performed as an inpatient procedure, amounted to €3789. The estimated total 3 years cost to the German SHI was €27.8 million for the stent and €44.1 million for TRAB.
Conclusions :
Ab interno stent (or TB stent) is a cost-saving treatment option compared with TRAB in the treatment of primary OAG, PEX, and pigmentary glaucoma (or OAG) in Germany over a 3 year period. Additionally, increasing the use of the stent in the outpatient setting and in combination with cataract surgery has the potential to reduce costs further
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.