OBJECTIVES: To review the clinical evidence and estimate annual costs of MIGS with stents in mild-to-moderate or refractory glaucoma from a Spanish hospital perspective.

METHODS: Stent types and population examined: (a) trabecular bypass stent with or without cataract surgery (TB+C, TB) and suprachoroidal stent with cataract surgery (S+C) for mild-to-moderate glaucoma; and (b) subconjunctival stent with or without cataract surgery (SC+C, SC) for refractory glaucoma. A review of published trials identified patient characteristics, efficacy (proportion of stent-treated patients with intraocular pressure [IOP] 6-21mm Hg) and adverse events (AEs). Resource utilization for surgery, AEs, and ophthalmology visits were obtained via expert opinion. Unit costs of ophthalmologist visits, AE-related procedures, mitomycin, and surgeries were sourced from Oblikue and BOTplus databases. The price of stents was from the Valencia regional purchasing agency.

RESULTS: The efficacy rate was 67.0-100.0% in mild-to-moderate glaucoma (for TB+C, TB, or S+C) and 51.5-71.3% in refractory glaucoma (for SC+C or SC). Hypotony was most frequent in SC+C (24.6%) vs. TB+C (1.0%) and S+C (6.1%). Needling due to bleb failure occurred in 32.3% of SC+C patients. Other AEs include peripheral anterior synechiae (PAS) (≤6.7%), posterior capsular opacification (≤6.0%), stent obstruction (≤4%), and anterior chamber shallowing (≤3%). No AEs impacting hospital budget were observed for TB. Annual costs for TB+C, TB, S+C, SC+C and SC were €2,983, €2,023, €3,189, €4,081 and €2,877, respectively. Costs due to AEs were €61, €0, €77, €238, and €232, respectively. Ophthalmologist visit costs were €540, €406, €731, €1,009, and €929, respectively.

CONCLUSIONS: Annual treatment costs were highest for SC+C in refractory glaucoma, in part due to the cost of cataract surgery, ophthalmologist visits, and AEs. When considering costs of MIGS with stents, one must consider the population of interest, whether cataract surgery is performed, subsequent ophthalmologist visits, and the risk of AEs, in addition to the price of stents.