Development of a Computerized and Automated Cost-Effectiveness Analysis Application to Aid in Glaucoma Surgical Management.
Prasad Jaideep, Sood Shefali, Al-Aswad Lama A
AI Summary
A new software automates cost-effectiveness analysis for glaucoma surgeries (MIGS), showing comparable results to prior models, making this tool accessible for clinical decision-making and future research.
Abstract
Précis: In this article, we describe the development of validated software that automates cost-effectiveness analyses of minimally invasive glaucoma surgeries based on modifications to robust mathematical models of glaucoma progression and management discussed in previous literature.
Purpose
To develop a validated application to streamline the use of cost-effectiveness (CE) in clinical management and investigations of minimally invasive glaucoma surgeries (MIGS) in the US.
Design
Automated cost-utility analysis adapted from Markov models described in prior literature.
Participants
Patients of ages 65 years and older with mild to moderate primary open angle glaucoma irrespective of concurrent visually significant cataract.
Methods
Markov models simulating glaucoma progression through 37 states and death were constructed based on previous CE models of minimally invasive trabecular meshwork stents. These states represent combinations of various glaucoma severity (mild, moderate, advanced, and severe/blind) with differences in clinical management, including the use of up to 4 medications, selective laser trabeculoplasty, or incisional surgery. These are not mutually exclusive and are based on decisions related to the rate of thinning of the retinal nerve fiber layer. Rather than using fixed sets of transition probabilities for specific surgical interventions, new transition probabilities are dynamically derived based on the expected reduction in intraocular pressure related to visual field mean deviation decline. In addition to the generic MIGS arm, 2 comparison arms (cataract-surgery or medications-only) are included. Medication reduction, whole costs, and utilities are modifiable inputs in the model. Optimal and worst-case results are determined by uncomplicated or complicated (secondary surgical intervention required/medication nonadherence) intervention outcomes. The model was entirely re-implemented in R and validated by comparing results to TreeAge data.
Main outcome measures
Total costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER).
Results
An optimal-case 35-year CE-analysis of the implantation of Hydrus and iStent inject devices provided values of costs and QALY that were similar to prior data (R vs. TreeAge): Hydrus (Cost: $50,446.53 vs. $48,026.13; QALY: 12.18 vs. 12.26), iStent inject (Cost: $52,323.43 vs. $49,599.86; QALY: 12.13 vs. 12.21), cataract (Cost: $54,150.56 vs. $54,409.25; QALY: 12.03 vs. 12.04). Trends of ICER over time were also very similar.
Conclusions
Novel software is available to aid in CE analyses of MIGS with modifiable inputs and outcomes of interest. Such a tool makes CE more accessible for use in clinical management decisions and may guide future investigation.
MeSH Terms
Shields Classification
Key Concepts6
An optimal-case 35-year cost-effectiveness analysis of the implantation of Hydrus devices yielded a cost of $50,446.53 and 12.18 quality-adjusted life years (QALY), which were similar to prior data (R vs. TreeAge: Cost: $50,446.53 vs. $48,026.13; QALY: 12.18 vs. 12.26).
An optimal-case 35-year cost-effectiveness analysis of the implantation of iStent inject devices yielded a cost of $52,323.43 and 12.13 quality-adjusted life years (QALY), which were similar to prior data (R vs. TreeAge: Cost: $52,323.43 vs. $49,599.86; QALY: 12.13 vs. 12.21).
An optimal-case 35-year cost-effectiveness analysis for cataract surgery as a comparison arm yielded a cost of $54,150.56 and 12.03 quality-adjusted life years (QALY), which were similar to prior data (R vs. TreeAge: Cost: $54,150.56 vs. $54,409.25; QALY: 12.03 vs. 12.04).
A validated software automates cost-effectiveness analyses of minimally invasive glaucoma surgeries (MIGS) based on modifications to robust mathematical models of glaucoma progression and management.
The developed application streamlines the use of cost-effectiveness (CE) in clinical management and investigations of minimally invasive glaucoma surgeries (MIGS) in the US for patients aged 65 years and older with mild to moderate primary open angle glaucoma, irrespective of concurrent visually significant cataract.
Markov models simulating glaucoma progression through 37 states and death were constructed based on previous cost-effectiveness models of minimally invasive trabecular meshwork stents. These states represent combinations of various glaucoma severity (mild, moderate, advanced, and severe/blind) with differences in clinical management, including the use of up to 4 medications, selective laser trabeculoplasty, or incisional surgery.
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