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AIM: To evaluate the cost-utility of iStent inject(®) with cataract surgery vs cataract surgery alone in patients with mild-to-moderate primary open angle glaucoma (POAG) in the Japanese setting from a public payer's perspective. METHODS: A Markov model was adapted to estimate the cost-utility of iStent inject(®) plus cataract surgery vs cataract surgery alone in one eye in patients with mild-to-moderate POAG over lifetime horizon from the perspective of Japanese public payer. Japanese sources were used for patients' characteristics, clinical data, utility, and costs whenever available. Non-Japanese data were validated by Japanese clinical experts. RESULTS: In the probabilistic base case analysis, iStent inject(®) with cataract surgery was found to be cost-effective compared with cataract surgery alone over a lifetime horizon when using the ¥5 000 000/quality-adjusted life year (QALY) willingness-to-pay threshold. The incremental cost-utility ratio (ICUR) was estimated to be ¥1 430 647/QALY gained and the incremental cost-utility ratio (ICER) was estimated to be ¥12 845 154/blind eye avoided. iStent inject(®) with cataract surgery vs cataract surgery alone was found to increase costs (¥1 025 785 vs ¥933 759, respectively) but was more effective in increasing QALYs (12.80 vs 12.74) and avoiding blinded eyes (0.133 vs 0.141). The differences in costs were mainly driven by costs of primary surgery (¥279 903 vs ¥121 349). In the scenario analysis from a societal perspective, which included caregiver burden, iStent inject(®) with cataract surgery was found to dominate cataract surgery alone. CONCLUSION: The iStent inject(®) with cataract surgery is a cost-effective strategy over cataract surgery alone from the public payer's perspective and cost-saving from the societal perspective in patients with mild-to-moderate POAG in Japan.

Original Article, Introduction: Bruch's membrane opening-minimum rim width (BMO-MRW) is measured perpendicular to the neural tissue axis and considers the variable trajectory of axons over the point of measurement, similar to the measurement strategies used for circumpapillary retinal nerve fiber layer thickness (c-RNFLT). However, changes in BMO-MRW in relation to those in c-RNFLT with intraocular pressure (IOP) reduction remain unclear. This study evaluated changes in BMO-MRW and their relationship to changes in the optic nerve head cup size and c-RNFLT in patients with open-angle glaucoma post-trabeculectomy (TLE). Methods: Thirty-one eyes of 31 patients were enrolled. All patients underwent fundus imaging with spectral domain-optical coherence tomography before and three months after TLE. We measured BMO-MRW and c-RNFLT and evaluated the cup size by calculating the cup profile area using the ImageJ program. Results: Reduction of IOP led to a significant increase in BMO-MRW and a significant decrease in cup size. Changes in the BMO-MRW of the whole disc and the temporal superior segments correlated significantly with the change in IOP. In multiple regression analysis, there was a significant relationship between the changes in cup size and axial length (but not the change in IOP) and the change in BMO-MRW. Although c-RNFLT did not increase significantly post-TLE, the mean deviation of the visual field at baseline, cup size at baseline, and change in cup size were considered to contribute to the change in c-RNFLT. Conclusions: BMO-MRW increased after adequate TLE-induced reduction of IOP. The increase in BMO-MRW was related to the cup size and reduction in axial length.

本研究は科学研究費補助金15H03303の研究成果の一部である。

Additional file 3: Figure S7. Scatter diagrams showing the associations between the mfPhNR/B of mfERG in each sector and the average thickness of the GCIPL, mRNFL, and GCC of OCT in glaucoma patients. mfPhNR/B: multifocal photopic negative response to multifocal B-wave ratio, mfERG: multifocal electroretinogram, GCIPL:Ganglion cell-inner plexiform layer, mRNFL: Macular retinal nerve fiber layer, GCC: Ganglion cell complex, OCT: Optical coherence tomopraphy, Ave: Average

Additional file 1: Figure S5. Scatter diagrams showing the associations between the N/T of mfERG, the macula thickness of OCT, and the mean thresholds and the total deviation of HFA 10–2 in each sector in glaucoma patients. N/T or NT: Nasal to temporal amplitude ratio, mfERG: multifocal electroretinogram, OCT; Optical coherence tomopraphy, HFA 10–2: Humphrey Field Analyzer Program Central 10–2, GCIPL:Ganglion cell-inner plexiform layer, Ave: Average, SN: Superonasal, IN: Inferonasal, ST: Superotemporal, IT: Inferotemporal, I: Inferior, S: Superior, mRNFL: Macular retinal nerve fiber layer, GCC: Ganglion cell complex, MD: Mean deviation, MT: Mean threshold, TD: Total deviation