A Brazilian cost-utility analysis of trabecular micro-bypass with iStent inject® for the treatment of open-angle glaucoma

Abstract

Purpose: To evaluate the cost-utility of the iStent inject ® for the treatment of mild-to-moderate open- angle glaucoma (OAG) within the Brazilian Unified Health System (SUS). Methods: A Markov model was developed, in which the effectiveness outcome measure was the incremental cost-effectiveness ratio (ICER: R$ / QALY quality-adjusted life-year). Direct medical costs were obtained from the SUS perspective. The base case comprised of a hypothetical cohort of patients with OAG using topical medication and being managed according to the Clinical Protocol and Therapeutic Guidelines (PCDT) and a real-world setting based on data from Datasus. The model’s robustness through sensitivity analyses was tested. Results: In the PCDT base case setting, the trabecular micro-bypass implant provided gains of 0.47 QALYs and an ICER of R$7,996.66/QALY compared to treatment with topical medication. In the real-world setting based on data from Datasus, the trabecular micro-bypass implant, provided gains of 0.47 QALYs and an ICER of R$4,485.68/QALY compared to treatment with topical medication. The results were robust to sensitivity analyses. Conclusion: Incorporating iStent inject® to SUS provides an improvement in the patient’s quality of life with an additional cost that warrants the benefit provided to patients. Results may be considered cost-effective compared to topical medication.