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A Cost-Utility Analysis of Trabecular Bypass Devices Versus Usual Care for Patients With Open-Angle Glaucoma


  • Paul R. Healey

    (University of Sydney)

  • Dominic Tilden

    (THEMA Consulting Pty Ltd)

  • Dan Jackson

    (THEMA Consulting Pty Ltd)

  • Lara Aghajanian

    (THEMA Consulting Pty Ltd)


Objective The aim of this study was to determine whether insertion of a trabecular bypass device (TBD) is a cost-effective intervention for the treatment of open-angle glaucoma (OAG) with mild to moderate vision loss in the Australian setting. Methods We performed a cost-utility analysis of TBD implantation in conjunction with cataract surgery or as a standalone procedure in patients with OAG. The model used a Monte Carlo simulation to follow individual patients through a glaucoma treatment algorithm that included TBD and compared the costs and outcomes with those of patients simulated through an algorithm without TBD (usual care). The model tracked the intraocular pressure (IOP) of individual patients and then, based on this IOP, tracked the progression of the patient’s glaucoma. Utility values were assigned dependent on severity of glaucoma. The analysis took the perspective of the Australian health care system. The main outcome was incremental cost per quality-adjusted life-year (QALY) of TBD versus usual care for the treatment of OAG. Results In the cataract surgery population, TBD surgery was associated with incremental healthcare costs of A$177 and 0.0726 QALYs per patient, resulting in an incremental cost per QALY gained of A$2430. In the standalone population, the overall incremental cost of TBD surgery versus usual care was A$2234. With QALYs gained of 0.1526 per patient, this equated to an incremental cost per QALY gained ratio of A$14,644. Conclusion The incremental cost per QALY estimates for TBD were below thresholds generally accepted by Australian healthcare payers, suggesting that TBD is a cost-effective intervention for patients with primary OAG in the Australian setting.

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  • Paul R. Healey & Dominic Tilden & Dan Jackson & Lara Aghajanian, 2022. "A Cost-Utility Analysis of Trabecular Bypass Devices Versus Usual Care for Patients With Open-Angle Glaucoma," PharmacoEconomics - Open, Springer, vol. 6(3), pages 355-365, May.
  • Handle: RePEc:spr:pharmo:v:6:y:2022:i:3:d:10.1007_s41669-021-00312-4
    DOI: 10.1007/s41669-021-00312-4

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    References listed on IDEAS

    1. Anthony H. Harris & Suzanne R. Hill & Geoffrey Chin & Jing Jing Li & Emily Walkom, 2008. "The Role of Value for Money in Public Insurance Coverage Decisions for Drugs in Australia: A Retrospective Analysis 1994-2004," Medical Decision Making, , vol. 28(5), pages 713-722, September.
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