Minimally Invasive Glaucoma Surgery (MIGS) for individuals with glaucoma. A health technology assessment

Key messages: This health technology assessment (HTA) summarises and supplements a 2019 Canadian HTA on the effectiveness and safety of micro-invasive glaucoma surgery (MIGS) versus other treatment options. Further, it contains cost-effectiveness analysis based on the Canadian HTA, in addition to patient partners’ considerations, organizational and ethical considerations relevant to discussions of MIGS’ role in Norwegian routine care. The Canadian evidence, which included 32 studies and 24 comparisons, was inconclusive due to very low to low certainty. Our supplementary findings show that: • MIGS with Hydrus Microstent combined with cataract surgery reduces intraocular pressure (IOP) at 24 months, compared with cataract surgery alone (high-certainty evidence) • MIGS with iStent inject combined with cataract surgery probably reduces IOP at 24 months, compared with cataract surgery alone (moderate-certainty evidence) • For other techniques there is either no or little difference between the MIGS and control interventions, or it is uncertain whether there is a difference in effectiveness • Neither MIGS procedures, nor alternative surgical strategies appear to be at high risk of adverse events • Lifetime total cost for glaucoma treatment ranged from NOK 30 000 to NOK 83 000 per patient, depending on treatment strategy and baseline disease stage. The incremental Quality adjusted life years (QALYs) for MIGS between comparators ranged between – 0.080 and 0.057 • MIGS is suitable as a outpatient surgery without hospital admission. Clinicians need training. Clear criteria for patient selection shuld be developed. Experts predict that the number of MIGS procedures may increase to twice as many in 2024 than today • The clinical evidence on MIGS is limited. The main reason for this is the lack of comparative studies. Our health economic evaluation shows some scenarios where MIGS may be cost-effective, depending on comparator and disease stage. Our analysis puts individuals with glaucoma in severity class 1.