Observational studyOphthalmology. Glaucoma
Impact of iStent Micro-Bypass Shunt on Medicare Part B Glaucoma Surgical Expenditure.
Observational study in Ophthalmology. Glaucoma. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Clinical outcomes of combined cataract surgery with iStent injectGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2025Article
- Variation of iStent Procedure Rates by State in Response to the COVID-19 Pandemic.Clinical ophthalmology (Auckland, N.Z.) · 2022Article
- GlaucoMap - Distribution of Glaucoma Surgical Procedures in the United States.Clinical ophthalmology (Auckland, N.Z.) · 2020Article
- Minimally Invasive Glaucoma Surgeries, Health Economics, and the Moral Imperative of Equity in Glaucoma Care.Journal of current glaucoma practiceArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
purposeTo examine the impact of the iStent (Glaukos) on the recent glaucoma surgical expenditure for Medicare Part B beneficiaries.
designRetrospective, observational, population-based analysis.
participantsAll applicable cases in the Centers for Medicare and Medicaid Services Part B Summary Data Files.
methodsThe Part B National Summary Data Files from 2007 to 2017 were obtained through the Centers for Medicare and Medicaid Services. Glaucoma surgical procedures, including trabeculectomy, glaucoma drainage implants (GDIs), and select minimally invasive glaucoma surgeries (MIGS) including the iStent, were queried from the database using Current Procedural Terminology (CPT) codes. We used Chow's test to confirm significant changes in expenditure trajectories. We built a mixed-effects regression model to examine the effect of demographic factors on each state's iStent adoption speed.
main outcome measuresProportion of iStent in total glaucoma surgical spending for individual states for each year.
resultsTotal Medicare part B payment for the selected glaucoma procedures increased 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 the Food and Drug Administration in 2012, increased to represent 57.9% of total payment by 2017. There were significant changes in the slope of glaucoma surgical Medicare payment (P < 0.00001) and iStent payment (P < 0.0001) trajectories in 2012. Mixed-effect regression analysis showed a wide range among the states' rates of increase in iStent proportion between 2012 and 2017 (range, 5.12%-14.54% per year). Higher male proportion in the population was associated with faster increases in iStent proportions (12.4% per 5% increase in male proportion, 95% confidence interval [CI], 4.3-20.5, P = 0.003). Higher median age of the population was associated with slower increases (-3.6% per 1-year increase in median age, 95% CI, -0.4 to -6.8, P = 0.026).
conclusionsIncreasing payment for the iStent represents the majority of the increase in glaucoma surgical spending in the recent decade. Male gender and age significantly affect the state-wise speed of adoption for the iStent. The impact of the iStent on the comprehensive glaucoma Medicare expenditure in the same time period warrants further study.
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