title: Mydriasert pupillary dilation for cataract surgery: an economic and clinical study.
abstract: BACKGROUND
  Mydriasert is an insoluble ophthalmic insert indicated for mydriasis prior to cataract surgery, which gradually releases the active ingredients: tropicamide (0.25 mg) and phenylephrine (5.38 mg). This study aimed to evaluate the cost of Mydriasert compared with conventional mydriatic eye drops to induce pupil dilation prior to cataract surgery using a budget impact model.
  
  
  METHODS
  A cohort-based, decision tree, budget impact model was developed to estimate the drug, consumable and staff costs for achieving mydriasis with Mydriasert compared to mydriatic eye drops (tropicamide [1%] plus phenylephrine [10%]). Insights from structured interviews with clinicians (n = 5) experienced in using both Mydriasert and mydriatic eye drops and results from the current clinical study of patients undergoing cataract surgery (n = 144) at a Greater London district general hospital were used to obtain key input parameters for the model, and to validate the model approach.
  
  
  RESULTS
  The base case analysis in a cohort of 1763 patients undergoing cataract surgery showed that when Mydriasert substituted mydriatic eye drops, annual total costs decreased by 18% and annual total nurse time decreased from 235.1 hours to 44.1 hours over one year (2012-2013).
  
  
  CONCLUSIONS
  This study demonstrated that despite its higher unit cost than mydriatic eye drops, Mydriasert resulted in overall savings in health-care costs, mainly associated with reduced nursing time. The economic model developed could assist National Health Service managers and local payers to estimate the budget impact of the introduction of Mydriasert into different clinical settings.
authors.affiliation: Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK. ameetshah001@gmail.com.
authors.forename: Ameet
authors.initials: A
authors.lastname: Shah
authors.affiliation: Health Economic Modelling Unit, HERON™ Commercialization, PAREXEL International, London, UK. Sukhvinder.Johal@parexel.com.
authors.forename: Sukhvinder
authors.initials: S
authors.lastname: Johal
authors.affiliation: Department of Ophthalmology, Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK. nick@leemedical.co.uk.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000191:economics*; D004338:Drug Combinations; D016527:Drug Costs; D004343:Drug Implants / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009184:Mydriatics / Q000008:administration & dosage / Q000191:economics*; D009313:National Health Programs / Q000191:economics; D010656:Phenylephrine / Q000008:administration & dosage / Q000191:economics; D011680:Pupil / Q000187:drug effects*; D014331:Tropicamide / Q000008:administration & dosage / Q000191:economics; D006113:United Kingdom
chemical_list: D004338:Drug Combinations; D004343:Drug Implants; D009184:Mydriatics; D010656:Phenylephrine; D014331:Tropicamide