Direct Costs of Second Aqueous Shunt Implant Versus Transscleral Cyclophotocoagulation (The Assists Trial).

Autor:	Ma JX; Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)., Chuang AZ; Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)., Feldman RM; Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)., Mansberger SL; Devers Eye Institute, Legacy Research Institute, Portland, OR., Tanna AP; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL., Blieden LS; Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).; Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine., Shoham D; Department of Anesthesiology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston., Bell NP; Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).; Eye Center of Texas, Bellaire, TX., Gross RL; Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine.; Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV.; Southern Eye Group of Alabama, Mobile, AL., Pasquale LR; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai., Greenfield DS; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, FL., Liebmann JM; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY., Weinreb RN; Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, CA.
Jazyk:	angličtina
Zdroj:	Journal of glaucoma [J Glaucoma] 2023 Mar 01; Vol. 32 (3), pp. 145-150. Date of Electronic Publication: 2023 Feb 01.
DOI:	10.1097/IJG.0000000000002143
Abstrakt:	Prcis: The cost of cyclophotocoagulation is less than the cost of a second glaucoma drainage device. Purpose: To compare the total direct costs of implantation of a second glaucoma drainage device (SGDD) with transscleral cyclophotocoagulation (CPC) for patients with inadequately controlled intraocular pressure (IOP) reduction, despite the presence of a preexisting glaucoma drainage device in the ASSISTS clinical trial. Methods: We compared the total direct cost per patient, including the initial study procedure, medications, additional procedures, and clinic visits during the study period. The relative costs for each procedure during the 90-day global period and the entire study period were compared. The cost of the procedure, including facility fees and anesthesia costs, were determined using the 2021 Medicare fee schedule. Average wholesale prices for self-administered medications were obtained from AmerisourceBergen.com. The Wilcoxon rank sum test was used to compare costs between procedures. Results: Forty-two eyes of 42 participants were randomized to SGDD (n=22) or CPC (n=20). One CPC eye was lost to follow-up after initial treatment and was excluded. The mean (±SD, median) duration of follow-up was 17.1 (±12.8, 11.7) months and 20.3 (±11.4, 15.1) months for SGDD and CPC, respectively ( P =0.42, 2 sample t test). The mean total direct costs (±SD, median) per patient during the study period were $8790 (±$3421, $6805 for the SGDD group) and $4090 (±$1424, $3566) for the CPC group ( P <0.001). Similarly, the global period cost was higher in the SGDD group than in the CPC group [$6173 (±$830, $5861) vs. $2569 (±$652, $2628); P <0.001]. The monthly cost after the 90-day global period was $215 (±$314, $100) for SGDD and $103 (±$74, $86) for CPC ( P =0.31). The cost of IOP-lowering medications was not significantly different between groups during the global period ( P =0.19) or after the global period ( P =0.23). Conclusion: The total direct cost in the SGDD group was more than double that in the CPC group, driven largely by the cost of the study procedure. The costs of IOP-lowering medications were not significantly different between groups. When considering treatment options for patients with a failed primary GDD, clinicians should be aware of differences in costs between these treatment strategies. Competing Interests: Disclosure: Dr R.L.G. reports personal fees from Aerie during the conduct of the study; membership of Data and Safety Monitoring Board for Glauckos and consultant and stockholder for Intelligent Retinal Imaging Systems, outside the submitted work. Dr D.S.G. reports personal fees (consultant) from Allergan, Alcon, Aerie, and Eyenovia outside the submitted work. Dr L.R.P. reports grants from NIH, The Glaucoma Foundation, and Research to Prevent Blindness, as well as personal fees from Eyenovia, Twenty-Twenty, and Skye Biosciences outside the submitted work. Dr S.L.M. reports a research grant from AbbVie and the National Eye Institute (outside the submitted work); and consulting fees from Nicox and Thea. Dr A.P.T. reports grants or contracts from Google and Research to Prevent Blindness (to Northwestern University); consulting fees from Ivantis, Sandoz, and Zeiss; and payment for expert testimony from Ivantis. Dr R.N.W. reports personal fees (consultant) from Abbvie, Allergan, Amydis, Aerie, Equinox, Eyenovia, Iantrek, Implandata, IOPtic, Nicox, Perivision, Topcon Medical. He reports research support from the National Eye Institute, National Institute of Minority Health and Health Disparities, Bausch + Lomb, Heidelberg Engineering, Zeiss-Meditec, Optovue, Centervue, and Topcon. Dr R.M.F. reports personal fees from Bausch and Lomb and Catawba; stock in 4DMD; and grants from Santen and Ivantis outside the submitted work. Dr L.S.B. reports personal fees (consultant) from Allergan, Abbive and Aerie outside the submitted work. The remaining authors declare no conflict of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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