Presentation (CTI)

OBJECTIVES: To develop a cohort simulation model for adaptation across European countries that estimates the cost impact of Trabecular Micro-Bypass (TMB) in combination with cataract surgery on glaucoma-related resource utilisation.
METHODS: We developed a MS Excel model to simulate the resource utilisation of patients undergoing TMB in combination with cataract surgery on a 5-year time horizon. The analysis adopted the health system perspective. We estimated that 6.77% of the patients are comorbid with cataract and open-angle glaucoma resulting in an eligible population of 3,726 patients. The cost impact was estimated across five resource categories: antiglaucoma medications, filtering procedures, routine visits, glaucoma-related fractures and blindness. In the base case, we applied reductions of 80%, 55%, 50%, 50%, and 25% to the five resource categories, respectively. The cost of the TMB implant was €1,400. Multiple breakeven scenarios were modelled.
RESULTS: The use of TMB reduced total system treatment costs by €10.95 million over the 5-year time horizon. Across the five domains, TMB reduced the cost of routine visits by €4.19 million followed by €3.08 million in glaucoma-related fractures, €2.53 million in medications, €0.90 million in filtering procedures, and €0.25 million in the costs associated with blindness. The investment attributable to the early TMB intervention totalled €5.22 million resulting in a net benefit of €5.73 million. This equates to €1,540 per eligible patient and ratio of 2.10 offset versus interventional costs. In an alternative scenario, the breakeven threshold was reached (i.e. a net benefit of €0.26 million) when all effect assumptions were reduced to approximately 50% of the base case.
CONCLUSIONS: Early intervention of TMB at the time of cataract surgery could be associated with health system cost savings when the total cost of care is considered. Localisation with real-world data is required to further increase confidence in the model outcomes.