Minimally invasive glaucoma surgery (MIGS) has the potential to become standard of care for patients with primary open angle glaucoma (POAG), whether combined with cataract surgery (CS) or as a standalone procedure. This study provides evidence of cost-effectiveness for Hydrus Microstent for both indications in UK healthcare settings. A cohort Markov model simulated the natural history of POAG to assess costs and quality-adjusted life years (QALYs) over a 15-year horizon, comparing Hydrus Microstent + CS with CS alone, and Hydrus Microstent to iStent standalone. Patient progression across glaucoma severity health states was modelled using a rate of progression (RoP) derived from 5-year visual field loss data in HORIZON trial (for mild to moderate POAG) and by trial-based annual number of medications from COMPARE trial (for moderate POAG), respectively. Conducted from the public healthcare payer perspective, model inputs were derived from UK publicly available sources and/or publications. Both deterministic and probabilistic analyses (PA) were performed. When compared with CS alone, Hydrus + CS was estimated to generate 0.334 more QALYs but £604 higher costs over the 15-year time horizon. When comparing Hydrus to iStent, Hydrus had £534 in projected savings and generated 0.068 more QALYs. The PA showed that the probability of Hydrus + CS being cost-effective compared to CS alone is 87.6%, and about 71.5% when compared to iStent. The results were consistent across scenario analyses. Hydrus implantation is a cost-effective strategy both in combination with CS (for mild-to-moderate POAG) and as a standalone procedure (for moderate POAG) in UK healthcare settings.
