iStent inject ® and cataract surgery for mild-to-moderate primary open angle glaucoma in Japan: a cost-utility analysis

• Published in: International journal of ophthalmology 2022-06, Vol.15 (6), p.954-961
• Main Authors: Igarashi, Ataru, Ishida, Kyoko, Shoji, Nobuyuki, Chu, Alice, Falvey, Heather, Han, Ru, Ueyama, Maki, Onishi, Yoshie
• Format: Article
• Language: English
• Subjects: cataract surgery; Clinical Research; cost-utility; glaucoma; health-economic model; istent inject
• ISSN: 2222-3959; 2227-4898
• DOI: 10.18240/ijo.2022.06.13

To evaluate the cost-utility of iStent with cataract surgery cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective. A Markov model was adapted to estimate the cost-utility of iStent plus cataract surgery cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. In the probabilistic base case analysis, iStent with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent with cataract surgery cataract surgery alone was found to increase costs (¥1 025 785 ¥933 759, respectively) but was more effective in increasing QALYs (12.80 12.74) and avoiding blinded eyes (0.133 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent with cataract surgery was found to dominate cataract surgery alone. The iStent with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.