July 2019
Volume 60, Issue 9
ARVO Annual Meeting Abstract  |   July 2019
Budget impact analysis of trabecular bypass stenting versus trabeculectomy for the treatment of open-angle glaucoma (OAG) from a German payer perspective
Author Affiliations & Notes
  • Patricia M Buchholz
    PBC Consulting, Karlsruhe, Baden-Württemberg, Germany
  • Andreas P Buchholz
    Ophthalmology, Städtisches Klinikum Karlsruhe, Karlsruhe, Baden-Württemberg, Germany
  • Sandor Bluemle
    Glaukos Germany GmbH, Wiesbaden, Germany
  • Heather Falvey
    Healthcare Economics and Outcomes Research, Glaukos, San Clemente, California, United States
  • Carolyn Steeds
    Valid Insight, London, United Kingdom
  • Footnotes
    Commercial Relationships   Patricia Buchholz, Glaukos Germany GmbH (C); Andreas Buchholz, Glaukos Germany GmbH (C); Sandor Bluemle, Glaukos Germany GmbH (E); Heather Falvey, Glaukos (E); Carolyn Steeds, Glaukos Germany GmbH (C)
  • Footnotes
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Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5452. doi:
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      Patricia M Buchholz, Andreas P Buchholz, Sandor Bluemle, Heather Falvey, Carolyn Steeds; Budget impact analysis of trabecular bypass stenting versus trabeculectomy for the treatment of open-angle glaucoma (OAG) from a German payer perspective. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5452.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.


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