Cost analysis of childhood glaucoma surgeries using the US Medicaire allowable costs

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Health Economics

Background:

• Childhood glaucoma requires surgical intervention to manage elevated intraocular pressure (IOP).
• The cost-effectiveness of different surgical procedures for pediatric glaucoma is not well-established.
• Understanding the relative costs of surgical options is crucial for clinical and economic decision-making.

Purpose of the Study:

• To determine the relative cost-effectiveness of various surgical interventions for childhood glaucoma.
• To calculate the cost per millimeter of mercury (mm Hg) of intraocular pressure (IOP) reduction for each surgical method.

Main Methods:

• A review of representative studies was conducted to quantify IOP reduction and medication use for each surgical intervention.
• Costs were analyzed from a US perspective using Medicare allowable costs.
• Cost per mm Hg IOP reduction was calculated at 1 year postoperatively.

Main Results:

• Microcatheter-assisted circumferential trabeculotomy demonstrated the lowest cost/mm Hg IOP reduction at $226/mm Hg.
• Trabeculectomy showed the highest cost/mm Hg IOP reduction at $400/mm Hg.
• Other procedures like cyclophotocoagulation, ab-externo trabeculotomy, Ahmed glaucoma valve, Baerveldt glaucoma implant, and goniotomy had intermediate costs.

Conclusions:

• Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical approach for lowering IOP in pediatric glaucoma.
• Trabeculectomy is the least cost-efficient surgical method for managing childhood glaucoma.
• These findings can guide surgical choices to optimize resource allocation in pediatric glaucoma care.