OBJECTIVES : To estimate cost-effectiveness of trabecular micro-bypass stents versus laser trabeculoplasty for intraocular pressure control for patients with open-angle glaucoma, in terms of QALYs.

METHODS : A Markov model, with stages from 0 (ocular hypertension without glaucoma) to 5 and bilateral blindness, was developed inclusive of Colombian older than 40 years in 2018, from a societal perspective, comparing trabecular micro-bypass stents versus laser trabeculoplasty in terms of clinical and economic outcomes over a lifetime horizon. Both costs and health outcomes had an annual rate discount of 5%. Health outcomes were evaluated in terms of QALYs related with loss of visual acuity. The model includes hip fracture as a complication due to the loss of visual acuity. Trabecular micro-bypass costs include the joint use of timolol, and the costs of laser trabeculoplasty include the combined use of timolol+dorzolamide. Both direct and indirect healthcare cost were measured. For the measurement of the QALYs, a time-related adjustment was made related to the aging of the population, which affects more the population with loss visual acuity.

RESULTS : Trabecular micro-bypass stents were estimated to have 127,971 more discounted QALYs compared with laser trabeculoplasty. Cumulative costs at 40 years was $ 13.253.318 lower with trabecular micro-bypass stents than laser trabeculoplasty. Based on a willingness to pay of $6,000 GDP per capita, micro-bypass stents has a probability of 100% to be chosen. In the one-way sensitive analysis, with the lowest efficacy of trabecular micro-bypass and the highest efficacy of laser trabeculoplasty, trabecular micro-bypass stent is the dominant strategy.

CONCLUSIONS : Trabecular micro-bypass stents were estimated to be a highly cost-saving strategy due to more QALYs related to a lower rate of the population with loss of visual acuity in the long term, and because the costs associated with additional medications and complications are lower with trabecular micro-bypass stents.