Abstract
Purpose :
To quantify and to analyze the relative cost of various glaucoma surgical procedures and selective laser trabeculoplasty (SLT) per mm Hg intraocular pressure (IOP) reduction ($/mmHg).
Methods :
Published glaucoma treatment studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for a given treatment modality. Medicare allowable costs were used to calculate a newly introduced parameter - cost per mmHg IOP reduction- at 1,2,3,4 and 5 years postoperatively. Medicare-allowable fee data for 2020 were obtained from Centers for Medicare and Medicaid Services to calculate the costs (in 2020 US dollars) associated with each treatment assuming it was administered a hospital-based (facility) practice.Our calculations included all professional fees including anesthesia and facility fees. The dollars per relative value unit (RVU) conversion factor was $37.89, the estimated rate for 2020. Reimbursement was adjusted for the geographic modifier for Miami, Florida.
Results :
The relative cost per mmHg IOP reduction was highest in year 1 as it included both the surgical cost and cost of anti-glaucoma medications needed postoperatively. Most efficient as SLT ($66/mmHg at year 1) was substantially lower than all other glaucoma surgical interventions for the first 3 years.The most cost-efficient glaucoma surgery in the first year was trabeculectomy ($215/mmHg) and least was iStent ($1420/mmHg). Intermediate cost-efficiency modalities were for CPC $(446/mmHg) and BGI ($469/mmHg. The most cost-efficient MIGS procedure was Trabectome ($505/mmHg) followed by GATT ($748/mmHg).
Conclusions :
There is a wide variation in the costs to lower the IOP and reduce dependence on nonsurgical modalities. While there may well be a role for a more costly modality in individual cases, the high costs of some of the existing therapies should be considered when designing a treatment strategy.
This is a 2021 ARVO Annual Meeting abstract.