Impact of iStent Microbypass Shunt on Medicare Part B Glaucoma Surgical Expenditure

作者：Jun-Hui Lee, Anthony K Ma, J. Warren, C. Teng · 发表于：Ophthalmology Glaucoma · 年份：2020 · DOI：10.1016/j.ogla.2020.05.004 · 被引用次数：15 · 研究领域：Medicine

Purpose: To examine the impact of iStent on the recent glaucoma surgical expenditure for Medicare Part B beneficiaries. Design: Retrospective, observational, population-based analysis. Subjects and Participants: All applicable cases in the Centers for Medicare and Medicaid Services (CMS) Part B Summary Data Files. Methods: The Part B National Summary Data Files from 2007 to 2017 were obtained through CMS. Glaucoma surgical procedures, including trabeculectomy, glaucoma drainage implants (GDIs), and select minimally invasive glaucoma surgeries (MIGS) including iStent were queried from the database using Current Procedural Terminology codes. We used Chow’s test to confirm significant changes in expenditures trajectories. We built a mixed-effects regression model to examine the effect of demographic factors on each state’s iStent adoption speed. Main Outcome Measures: Proportion of iStent in total glaucoma surgical spending for individual states for each year. Results: Total Medicare part B payment for the selected glaucoma procedures rose from $52.0 million in 2007 to $179.9 million in 2017. The percentage for trabeculectomy and GDIs decreased from 92.3% to 21.2%. Conversely, the iStent, approved by FDA in 2012, rose to represent 57.9% of total payment by 2017. There were significant changes in the slope of glaucoma surgical Medicare payment (P<.00001) and iStent payment (P<.0001) trajectories in 2012. Mixed-effect regression analysis showed a wide range among the states’ rates...