Development of a Computerized and Automated Cost-Effectiveness Analysis Application to Aid in Glaucoma Surgical...

Area of Science:

• Ophthalmology
• Health Economics
• Medical Informatics

Background:

• Minimally invasive glaucoma surgeries (MIGS) offer new treatment avenues.
• Cost-effectiveness (CE) analysis is crucial for evaluating new surgical interventions.
• Existing CE models can be complex and time-consuming to implement.

Purpose of the Study:

• To develop and validate software for automating CE analyses of MIGS.
• To streamline the application of CE in clinical management and research of MIGS in the US.
• To provide a user-friendly tool for assessing the economic impact of MIGS.

Main Methods:

• Development of automated cost-utility analysis software using modified Markov models.
• Simulation of glaucoma progression through 37 states, including various management strategies and death.
• Dynamic derivation of transition probabilities based on intraocular pressure reduction and visual field decline.

Main Results:

• The software, implemented in R, produced CE results comparable to existing TreeAge models.
• Optimal-case 35-year CE-analysis showed similar costs and quality-adjusted life years (QALYs) for Hydrus, iStent inject, and cataract surgery.
• Incremental cost-effectiveness ratio (ICER) trends over time were also consistent between the software and prior data.

Conclusions:

• Validated software is now available to automate CE analyses for MIGS.
• The tool enhances accessibility of CE for clinical management decisions.
• This software can guide future research and investment in glaucoma interventions.