OBJECTIVES

Glaucoma is a progressive, irreversble eye disease that, if left untreated, can eventually cause blindness especially in those patients with cataracts. iStent® has been shown to be effective in reducing intraocular pressure, with an excellent safety profile for this group of patients. The objective is to perform a cost-effectiveness analysis in terms of incremental costs for years of blindness-free life to evaluate minimally invasive surgery using iStent® in combination with phacoemulsification compared to all alternatives currently employed in the Mexican public sector.

METHODS

A systematic review of the literature was developed for each of the comparators. Statistically significant differences were found between the use of phacoemulsification in combination with iStent®. A cost-effectiveness model was developed to capture the main benefits of iStent® use in clinical and economic terms. Specifically, a decision tree was developed where each branch symbolizes a treatment alternative. There are two post-operative health conditions: success or failure of surgery, defined by the number of patients who were able to reduce their intraocular pressure below 21mmHg. Subsequently, if the patients did not succeed, the disease will evolve into possible blindness. All costs were estimated by national public sources, and if necessary were updated to present value.

RESULTS

In a 5-year time horizon, treatment with iStent® and phacoemulsification turns out to be the dominant option; in other words, it is an alternative capable of generating savings of 1,230 MXN per patient and 0.049 years of life free of incremental blindness.

CONCLUSIONS

The iStent® technology should be the first choice for the treatment of glaucoma and cataract patients in Mexico, due to its ability to generate savings for public health institutions and medical benefits for patients.