The purpose of this HTA is to inform the policy questions through an assessment of the clinical effectiveness and safety, cost-effectiveness, patients’ perspectives and experiences, ethical issues, and implementation issues of minimally invasive glaucoma surgery devices and procedures for adults with glaucoma.

Contents

• External Reviewers
• Authorship
• Acknowledgements
• Abbreviations
• Protocol Amendments
• Executive Summary
  • Background
  • Clinical Evidence
  • Economic Evidence
  • Patients’ Perspectives and Experiences Evidence
  • Ethics Evidence
  • Implementation Issues Evidence
  • Conclusion
• 1. Introduction
  • 1.1. Background and Rationale
  • 1.2. Policy Question
• 2. Objective
  • 2.1. Research Questions
• 3. Clinical Review
  • 3.1. Methods
  • 3.2. Results
  • Research Question 1. What is the comparative clinical effectiveness of MIGS versus each other, pharmacotherapy, laser therapy, or filtration surgery, for the treatment of glaucoma in adults?
  • Research Question 2. What is the comparative safety of MIGS versus each other, pharmacotherapy, laser therapy, or filtration surgery, for the treatment of glaucoma in adults?
  • Research Question 3. What is the comparative clinical effectiveness of MIGS performed in combination with cataract surgery versus a) a different MIGS plus cataract surgery, b) filtration surgery plus cataract surgery, or c) cataract surgery alone for the treatment of glaucoma in adults?
  • Research Question 4. What is the comparative safety of MIGS performed in combination with cataract surgery versus a) a different MIGS plus cataract surgery, b) filtration surgery plus cataract surgery, or c) cataract surgery alone for the treatment of glaucoma in adults?
  • 3.3. Integration of Outcomes
  • 3.4. Summary of Results
• 4. Economic Evaluation
  • 4.1. Methods
  • 4.1.8. Assumptions
  • 4.2. Results
  • 4.3. Summary of Results
• 5. Patients’ Perspectives and Experiences Review
  • Overview
  • 5.1. Methods
  • 5.2. Results
  • 5.3. Summary of Results
• 6. Ethical Issues Analysis
  • Review of Empirical and Normative Bioethics Literature
  • 6.1. Methods
  • 6.2. Results
  • 6.3. Summary of Results
• 7. Implementation Issues Analysis
  • 7.1. Methods
  • 7.2. Results
  • 7.3. Summary of Results
• 8. Discussion
  • 8.1. Treatment Impact
  • 8.2. Access
  • 8.3. Professional Considerations
  • 8.4. Population Considerations
  • 8.5. Generalizability
  • 8.6. Limitations
  • 8.7. Directions for Future Research
• 9. Conclusions
• References
• Appendix 1. Minimally Invasive Glaucoma Surgery Devices and Procedures of Interest
• Appendix 2. Literature Search Strategies
• Appendix 3. Major and Minor Adverse Events — Clinical Review
• Appendix 4. Study Selection Flow Diagram — Clinical Review
• Appendix 5. List of Included Studies — Clinical Review
• Appendix 6. List of Excluded Studies and Reasons for Exclusion — Clinical Review
• Appendix 7. Included Comparisons and Rationale Regarding Meta-Analyses — Clinical Review
• Appendix 8. Characteristics of Included Studies — Clinical Review
• Appendix 9. Validity of Intraocular Pressure Outcome Measure
• Appendix 10. Baseline Patient Characteristics — Clinical Review
• Appendix 11. Primary Study Author Disclosures — Clinical Review
• Appendix 12. Detailed Outcome Data — Clinical Review
• Appendix 13. GRADE Evidence Profile Tables — Clinical Review
• Appendix 14. Additional Meta-Analysis of Clinical Data for the Economic Evaluations
• Appendix 15. Detailed Economic Model Inputs
• Appendix 16. Incremental Cost-Effectiveness Planes
• Appendix 17. Study Selection Flow Diagram — Patients’ Perspectives and Experiences Review
• Appendix 18. Included Studies — Patients’ Perspectives and Experiences Review
• Appendix 19. Participant Characteristics From Included Studies — Patients’ Perspectives and Experiences Review
• Appendix 20. Quality Assessment of Included Studies — Patients’ Perspectives and Experiences Review

Dr. Cindy Hutnik has received funding from Allergan for research and for being on a user’s group panel, and from Medicus for writing articles or editorials and being on an expert panel on glaucoma management. The other authors declared no conflicts of interest relevant to this report.

Suggested citation:

Optimal use of minimally invasive glaucoma surgery: a health technology assessment. Ottawa: CADTH; 2019. (CADTH optimal use report; vol.8, no.1b).

Disclaimer: This report is prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). This report contains a comprehensive review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) available to CADTH at the time it was prepared, and it was guided by expert input and advice throughout its preparation.

The information in this report is intended to help health care decision-makers, patients, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment in respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this report to ensure that its contents are accurate, complete, and up-to-date, CADTH does not make any guarantee to that effect. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or as a result of the use (or misuse) of any information contained in or implied by the information in this report

CADTH takes sole responsibility for the final form and content of this report. The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial or territorial government.

Production of this report is made possible through a financial contribution from Health Canada.