|Patients with concerns about glaucoma surgery cost may want to choose a more conventional surgical option as opposed to a newer MIGS procedure. Photo: Justin Schweitzer, OD. Click image to enlarge.|
Glaucoma management has recently evolved with the introduction of MIGS procedures, serving as middle-ground options to lower IOP early in the course of the disease. However, a new study found MIGS were less cost-efficient compared with conventional glaucoma surgeries and SLT, indicating the latter might be a better option when cost is a concern for patients.
Basing their findings on the cost per 1mm Hg reduction in IOP after one year, the study authors found the most cost-efficient incisional glaucoma surgery was trabeculectomy ($190/1mm Hg), while the least cost-efficient was the iStent (Glaukos, $1,376/1mm Hg). Other procedures ranked in the middle, including cyclophotocoagulation ($635/1mm Hg) and the Baerveldt glaucoma drainage implant ($450/1mm Hg).
The most cost-efficient MIGS procedure was Trabectome (Microsurgical Technology, $498/1mm Hg), followed by gonioscopy-assisted transluminal trabeculotomy ($719/1mm Hg).
The cost per 1mm Hg reduction in IOP decreased after the first year since calculations included only the price of glaucoma medications needed, assuming that no further surgeries were required, the investigators explained. With this formula, the cost per 1mm Hg for various surgeries ranged from $12/1mm Hg to $61/1mm Hg.
Effective cost of intervention was calculated as total free of intervention minus drop savings (for one year). The lowest cost was for SLT surgery ($571), followed by cyclophotocoagulation ($2,351) and trabeculectomy ($2,450). As expected, the effective cost of MIGS was high, ranging from $3,762 to $7,138.
“The multiplicity of treatment options for lowering IOP is both a blessing and a challenge,” the researchers wrote in their paper. “Some attention to cost analysis might assist in choosing an optimal therapy, especially in a cost-constrained, international setting.”
The results were based on a review of published glaucoma treatment studies, in addition to an analysis of Medicare allowable costs.
Annually, $1.9 billion is spent directly for medical expenses to treat glaucoma, while another $1.5 billion is spent indirectly on social security benefits and healthcare expenditures related to glaucoma-associated disabilities in the United States alone. The average annual direct cost of glaucoma treatment for an individual varies from $623 for mild severity to $2,511 for advanced cases.
Elhusseiny AM, Yannuzzi NA, Khodeiry MM, et al. Cost analysis of surgical intraocular pressure management in glaucoma. J Glaucoma. September 10, 2021. [Epub ahead of print].