[Trabeculectomy versus canaloplasty--utility and cost-effectiveness analysis]

Area of Science:

• Ophthalmology
• Surgical Innovation
• Health Economics

Background:

• Glaucoma treatment costs are a significant concern in public health systems.
• New interventions must demonstrate cost-utility alongside safety and efficacy.
• Diagnosis-related group (DRG) reimbursement models necessitate cost-effectiveness evaluations.

Purpose of the Study:

• To compare the cost and effort of canaloplasty versus trabeculectomy (TE) for glaucoma treatment.
• To evaluate the cost-utility of canaloplasty in the context of DRG reimbursement.
• To analyze resource utilization and patient outcomes for both surgical procedures.

Main Methods:

• Retrospective, consecutive case series comparing canaloplasty (Group I, 21 eyes) and trabeculectomy with mitomycin C (MMC) and intensive postoperative care (Group II, 48 eyes).
• Analysis of demography, hospitalisation duration, surgery duration, complications, interventions, and pre/post-operative intraocular pressure (IOP) within 6 months.
• Cost analysis including hospitalisation expenses and overall treatment costs.

Main Results:

• Canaloplasty patients had shorter hospitalisation (5.3 vs 10.7 days), surgery duration (77 vs 48 min), and fewer follow-up visits (2.8 vs 6).
• Both procedures effectively lowered IOP (Canaloplasty: 28.75 to 12.8 mmHg; TE: 34.5 to 10.3 mmHg).
• Canaloplasty required fewer interventions (4 vs 107) and re-admissions (0 vs 11), with lower mean hospitalisation costs (€821.50 vs €1658.50) and overall expenses (€2379.62 vs €2733.61).

Conclusions:

• Both canaloplasty and trabeculectomy effectively control intraocular pressure (IOP) in glaucoma patients.
• Canaloplasty demonstrates superior cost-effectiveness due to shorter hospitalisation, reduced need for interventions, and fewer re-admissions.
• Trabeculectomy is more resource-intensive, involving longer hospital stays and more frequent postoperative care, making it a costlier and more time-consuming option.