Cost-Effectiveness Analysis of Hydrus Microstent for patients with mild to moderate Primary Open-Angle Glaucoma in Canada.

Abstract

Objective: Assess the cost-effectiveness of Hydrus Microstent combined with cataract surgery (CS) versus CS alone, for treating patients with mild to moderate primary open angle glaucoma (POAG).

Design: Cost-utility analysis using efficacy and safety results of a pivotal randomized clinical trial SUBJECTS: Modeled cohort of patients with mild to moderate POAG and visually significant cataract METHODS: A semi-Markov model was developed to model effects and costs over a 15-year time horizon from the Canadian public healthcare payer perspective for patients with mild or moderate POAG receiving Hydrus Microstent during CS versus CS alone. The model utilizes the HORIZON trial patient cohort. Progression was guided using the annualized rate of progression (RoP) derived from a post-hoc analysis of 5-year visual field loss (VFL) data from the HORIZON trial. The amount of VF lost was mapped on a sequential addition of medications used as a proxy for irreversible progression. Costs were derived from various publicly available sources and publications. Utility values were sourced from a published analysis that conducted a mapping exercise based on Health Utilities Index mark 3 using Canadian tariffs. We conducted deterministic and probabilistic sensitivity analyses to examine uncertainty around alternative model input values. Scenario analyses explored structural uncertainty.

Main outcome measures: Total costs per patient, quality-adjusted life years (QALYs), and incremental cost-utility ratio (ICUR).

Results: Compared with CS alone, Hydrus + CS was a dominant strategy (greater benefits and lower costs). Although LYs were equivalent between the two treatments (11.41 years), Hydrus + CS arm was associated with higher benefits (9.351 vs. 9.040 in QALYs). This translated into an additional 0.311 QALYs for Hydrus + CS. Total costs were lower with Hydrus + CS (CAD 26,770 vs CAD 27,145) resulting into saving of -CAD 375. Results of scenario analyses showed robustness of the model. The CEAC shows a probability of 85.3% of Hydrus + CS being cost-effective compared with CS alone at a willingness-to-pay (WTP) threshold of 50,000/QALY.

Conclusions: Hydrus Microstent combined with CS is a cost-effective long-term treatment for patients with POAG.