Hydrus microstent combined with cataract surgery or used alone: cost-utility analysis for UK

Background Minimally invasive glaucoma surgery (MIGS) has the potential to become standard of care for patients with primary open angle glaucoma (POAG), whether combined with cataract surgery (CS) or as a standalone procedure. This study provides evidence of cost-effectiveness for Hydrus Microstent for both indications in UK healthcare settings. Methods A cohort Markov model simulated the natural history of POAG to assess costs and quality-adjusted life years (QALYs) over a 15-year horizon, comparing Hydrus Microstent + CS with CS alone, and Hydrus Microstent to iStent standalone. Patient progression across glaucoma severity health states was modelled using a rate of progression (RoP) derived from 5-year visual field loss data in HORIZON trial (for mild to moderate POAG) and by trial-based annual number of medications from COMPARE trial (for moderate POAG), respectively. Conducted from the public healthcare payer perspective, model inputs were derived from UK publicly available sources and/or publications. Both deterministic and probabilistic analyses (PA) were performed. Results When compared with CS alone, Hydrus + CS was estimated to generate 0.334 more QALYs but £604 higher costs over the 15-year time horizon. When comparing Hydrus to iStent, Hydrus had £534 in projected savings and generated 0.068 more QALYs. The PA showed that the probability of Hydrus + CS being cost-effective compared to CS alone is 87.6%, and about 71.5% when compared to iStent. The results were consistent across scenario analyses. Conclusions Hydrus implantation is a cost-effective strategy both in combination with CS (for mild-to-moderate POAG) and as a standalone procedure (for moderate POAG) in UK healthcare settings.