OMNI® surgical system versus iStent inject® with concomitant cataract surgery for the treatment of mild-to-moderate primary open-angle glaucoma in the United States: a cost utility analysis

ABSTRACT Background A Markov model was developed to investigate the cost utility of the OMNI® Surgical System (OMNI®) versus iStent inject® in patients with mild to moderate primary open angle glaucoma (POAG) during concomitant cataract surgery from a US Medicare perspective. Methods For patients aged 65 years and older with mild to moderate POAG and visually significant cataract, we simulated progression through four glaucoma states (mild, moderate, advanced, severe) and death, using 6-month cycles and a lifetime horizon. A systematic literature review identified effectiveness data to calculate health state transition probabilities. Direct costs included surgical procedures, physician fees, and intraocular pressure (IOP)-lowering medications using Medicare 2022 rates. Utilities were sourced from published literature. Model structure and inputs were validated by a panel of ophthalmologists in the US and UK. Main outcome measures were incremental cost/QALY gained and net monetary benefit (NMB). Results OMNI® dominated iStent inject® with $552 lower costs and a gain of 0.02 quality-adjusted life-years. Model robustness was tested through deterministic and probabilistic sensitivity analyses, with OMNI® being dominant or cost-effective. NMB was $1,422 using a $50,000 willingness-to-pay threshold. Conclusion OMNI® was less costly and more effective than iStent inject® over a lifetime perspective for mild-to-moderate POAG Medicare patients in need of cataract extraction.