Ophthalmology science · 2026
Cost-Effectiveness of the Smaller-Incision New Generation Implantable Miniature Telescope for Late-Stage Age-Related Macular Degeneration.
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Basile Michele, Valentini Ilaria, Calosci Elena Maria, Sciomenta Ilaria, Di Brino Eugenio, Rumi Filippo, Barca Francesco, De Angelis Lorenzo, Savastano Alfonso, Francione Giuseppe, Sasso Paola, Toro Mario Damiano, Giglio Rosa, Rizzo Stanislao
Аннотация
OBJECTIVE: To assess the cost-effectiveness of the smaller-incision new-generation implantable miniature telescope (SING IMT) versus conventional standard care (CSC) from the Italian National Health Service (NHS) and societal perspectives.
DESIGN: Model-based cost-utility analysis.
SUBJECTS: A simulated cohort of patients with bilateral late-/end-stage age-related macular degeneration (AMD), based on a prospective multicenter study population (mean age, 76 years) eligible for SING IMT, compared with a clinically comparable cohort receiving CSC.
METHODS: A cohort Markov model with quarterly cycles and a lifetime horizon evaluated monocular SING IMT implantation, structured 6-month postoperative low-vision rehabilitation, and scheduled ophthalmologic follow-up. Costs included device acquisition, surgery, rehabilitation, follow-up, wet AMD treatment and monitoring, visual impairment and blindness, and adverse-event management. Costs and outcomes were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses assessed uncertainty.
MAIN OUTCOME MEASURES: Incremental costs, life years (LYs), quality-adjusted life years (QALYs), incremental cost-utility ratio, and net monetary benefit (NMB) at a €40,000/QALY willingness-to-pay threshold.
RESULTS: In the deterministic base case, SING IMT provided 1.59 additional LYs and 1.27 additional QALYs versus CSC. From the NHS perspective, its incremental cost was €21,760.60, yielding incremental cost-effectiveness ratios of €13,712.33 per LY and €17,137.15 per QALY gained; incremental NMB was €29,031.05. Including societal blindness-related costs, SING IMT reduced total per-patient costs (€35,446.33 vs €74,035.45; difference, -€38,589.12), primarily through lower lifetime blindness costs. Thus, from the combined NHS and societal perspective, SING IMT was dominant, with an incremental NMB of €89,380.77. Results were robust in sensitivity analyses; baseline age was the main source of variability, whereas surgical time, visit frequency, and unit costs had marginal effects.
CONCLUSIONS: For appropriately selected Italian patients with late-stage AMD, SING IMT is expected to be cost-effective versus CSC, providing clinically meaningful gains in quality-adjusted survival. It is cost-effective but not cost-saving from the NHS perspective alone and becomes dominant when societal costs are included, owing mainly to avoided blindness-related expenditure. Findings are specific to the Italian health care context.
FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.
DESIGN: Model-based cost-utility analysis.
SUBJECTS: A simulated cohort of patients with bilateral late-/end-stage age-related macular degeneration (AMD), based on a prospective multicenter study population (mean age, 76 years) eligible for SING IMT, compared with a clinically comparable cohort receiving CSC.
METHODS: A cohort Markov model with quarterly cycles and a lifetime horizon evaluated monocular SING IMT implantation, structured 6-month postoperative low-vision rehabilitation, and scheduled ophthalmologic follow-up. Costs included device acquisition, surgery, rehabilitation, follow-up, wet AMD treatment and monitoring, visual impairment and blindness, and adverse-event management. Costs and outcomes were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses assessed uncertainty.
MAIN OUTCOME MEASURES: Incremental costs, life years (LYs), quality-adjusted life years (QALYs), incremental cost-utility ratio, and net monetary benefit (NMB) at a €40,000/QALY willingness-to-pay threshold.
RESULTS: In the deterministic base case, SING IMT provided 1.59 additional LYs and 1.27 additional QALYs versus CSC. From the NHS perspective, its incremental cost was €21,760.60, yielding incremental cost-effectiveness ratios of €13,712.33 per LY and €17,137.15 per QALY gained; incremental NMB was €29,031.05. Including societal blindness-related costs, SING IMT reduced total per-patient costs (€35,446.33 vs €74,035.45; difference, -€38,589.12), primarily through lower lifetime blindness costs. Thus, from the combined NHS and societal perspective, SING IMT was dominant, with an incremental NMB of €89,380.77. Results were robust in sensitivity analyses; baseline age was the main source of variability, whereas surgical time, visit frequency, and unit costs had marginal effects.
CONCLUSIONS: For appropriately selected Italian patients with late-stage AMD, SING IMT is expected to be cost-effective versus CSC, providing clinically meaningful gains in quality-adjusted survival. It is cost-effective but not cost-saving from the NHS perspective alone and becomes dominant when societal costs are included, owing mainly to avoided blindness-related expenditure. Findings are specific to the Italian health care context.
FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.