title: Economic analysis of the Ex-PRESS miniature glaucoma device versus trabeculectomy.
abstract: OBJECTIVE
  Ex-PRESS shunt is an alternative filtration procedure to trabeculectomy. This study aimed to compare the 1-year cost differences between the 2 operations.
  
  
  METHODS
  Subjects were enrolled in a randomized controlled trial comparing Ex-PRESS to trabeculectomy. Surgical cost difference and 1-year postoperative costs (follow-up visits, additional procedures, and medications) were determined and compared. The 95% confidence interval of incremental cost-effectiveness ratio was estimated using bootstrap method.
  
  
  RESULTS
  Forty-three subjects with 1-year follow-up were included. Success rate was not significantly different for Ex-PRESS (65%) versus trabeculectomy (55%, P=0.49). Ex-PRESS had a net surgical cost of $956 greater than trabeculectomy. There was no significant difference in the overall postoperative cost [median (interquartile range); $485 (337, 822) vs. $609 (387, 820), P=0.78], cost of follow-up visits [$303 (275, 358) vs. $317 (275, 385), P=0.75], additional procedures [$182 (0, 365) vs. $182 (0, 365), P=0.69], or glaucoma medication [$0 (0, 68) vs. $0 (0, 90), P=0.8] for Ex-PRESS versus trabeculectomy, respectively. The overall 1-year cost was significantly greater for Ex-PRESS and the incremental cost-effectiveness ratio was $9625 (95% confidence interval, $2435-548,084).
  
  
  CONCLUSIONS
  Ex-PRESS is associated with greater surgical cost compared with trabeculectomy. This needs to be considered in conjunction with efficacy and safety if Ex-PRESS is to supersede trabeculectomy.
authors: Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
authors: Hussain Y
authors: HY
authors: Patel
authors: Lilach Drori
authors: LD
authors: Wagschal
authors: Graham E
authors: GE
authors: Trope
authors: Yvonne M
authors: YM
authors: Buys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D020327:Glaucoma Drainage Implants / Q000191:economics*; D005902:Glaucoma, Open-Angle / Q000191:economics* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000191:economics*; D016896:Treatment Outcome