June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Development of a Computerized and Automated Cost-Effectiveness Analysis Application to Aid in Glaucoma Surgical Management
Author Affiliations & Notes
  • Jaideep Prasad
    NYU Grossman School of Medicine, New York, New York, United States
    Ophthalmology, NYU Langone Health, New York, New York, United States
  • Shefali Sood
    Ophthalmology, Georgetown University, Washington, District of Columbia, United States
  • Lama A. Al-Aswad
    InVision Health Technologies, Bronxville, New York, United States
  • Footnotes
    Commercial Relationships   Jaideep Prasad None; Shefali Sood None; Lama Al-Aswad AI Optics, Code C (Consultant/Contractor), Bausch & Lomb Americas Inc, Code C (Consultant/Contractor), Alcon, Code C (Consultant/Contractor), Mother Cabrini, Code F (Financial Support), GlobeChek, Code I (Personal Financial Interest), Virtual Field, Code I (Personal Financial Interest), Visi Health Technologies, Code O (Owner), Envision Health Technologies, Code O (Owner)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 378. doi:
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      Jaideep Prasad, Shefali Sood, Lama A. Al-Aswad; Development of a Computerized and Automated Cost-Effectiveness Analysis Application to Aid in Glaucoma Surgical Management. Invest. Ophthalmol. Vis. Sci. 2023;64(8):378.

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

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Purpose : To develop a validated application to streamline use of cost-effectiveness (CE) in clinical management and investigations of minimally invasive glaucoma surgeries (MIGS) in the United States.

Methods : Markov models simulating glaucoma progression through 37 states and death were constructed based on previous CE models of minimally invasive trabecular meshwork stents. These states represent combinations of various glaucoma severity (mild, moderate, advanced, and severe/blind) with differences in clinical management, including use of up to 4 medications, selective laser trabeculoplasty, or incisional surgery. These are not mutually exclusive and are based on decisions related to the rate of thinning of the retinal nerve fiber layer. Rather than using fixed sets of transition probabilities for specific surgical interventions, new transition probabilities are dynamically derived based on the expected reduction in intraocular pressure related to visual field mean deviation decline. In addition to the generic MIGS arm, two comparison arms (cataract-surgery or medications-only) are included. Medication reduction, whole costs, and utilities are modifiable inputs in the model. Optimal and worst-case results are determined by uncomplicated or complicated (secondary surgical intervention required/medication nonadherence) intervention outcomes. The model was entirely re-implemented in R and validated by comparing results to previously reported TreeAge data.

Results : An optimal-case 35-year CE-analysis of the implantation of Hydrus and iStent devices provided values of costs and quality adjusted life years (QALY) that were similar to prior data (R vs TreeAge): Hydrus (Cost: $47851.70 vs $48026.13; QALY: 12.26 vs 12.26), iStent (Cost: $48779.75 vs $49599.86; QALY: 12.20 vs 12.21), cataract (Cost: $54150.65 vs $54409.25; QALY: 12.03 vs 12.04). Trends of incremental cost-effectiveness ratios over time were also very similar. The software is freely available for use as a user-friendly R Shiny application. It includes support for analysis of up to 2 different MIGS interventions at a time, with options to download results and raw data.

Conclusions : Novel software is available to aid in CE analyses of MIGS with modifiable inputs and outcomes of interest. Such a tool makes CE more accessible for use in clinical management decisions and may guide future investigation.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.




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