ArticleBMC ophthalmology2026
Payer-perspective direct medical costs during observed postoperative follow-up after gonioscopy-assisted transluminal trabeculotomy versus mitomycin-augmented trabeculectomy in Turkey.
Article in BMC ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGlaucoma surgery has payer-budget implications when postoperative medication and procedure use differ between care pathways. This study compared direct medical costs after gonioscopy-assisted transluminal trabeculotomy (GATT) and mitomycin-C-augmented trabeculectomy (MMC-trabeculectomy) from the Turkish Social Security Institution (SGK) payer perspective.
methodsThis single-centre retrospective cohort used patient-level chart, operating-room, and medication-cost data from sequentially reviewed surgery-naive adults with primary open-angle or pseudoexfoliation glaucoma who underwent GATT (n = 40) or MMC-trabeculectomy (n = 20). Surgical outcome was not an enrollment criterion. Costs were valued in 2025 Turkish Lira using SUT tariffs and the 11 June 2025 SGK drug price list. The primary base-case cost included the index glaucoma-surgery tariff, postoperative ophthalmology visits, dispensed glaucoma medications, and glaucoma-related non-routine postoperative procedures. Routine optical coherence tomography and visual-field testing were excluded from the primary surgical cost comparison and reported descriptively. Patient-level Gamma generalized linear models with log link estimated procedure-associated cost ratios.
resultsMean observed postoperative follow-up was 11.45 ± 8.28 months after GATT (range 2-30) and 13.85 ± 6.91 months after MMC-trabeculectomy (range 3-25). Mean primary base-case direct medical cost was 3188.6 ± 1955.9 TRY after GATT and 6835.8 ± 4674.5 TRY after MMC-trabeculectomy. Medication cost was the largest incremental driver (924.0 vs. 3305.7 TRY per patient), accounting for 65.3% of the mean difference. Glaucoma-related non-routine procedure costs were 0.0 TRY per GATT patient and 271.1 TRY per MMC-trabeculectomy patient. In the fully adjusted Gamma model, MMC-trabeculectomy was associated with higher mean primary base-case cost (cost ratio 2.01; 95% CI, 1.50-2.70).
conclusionsIn this Turkish SGK payer-perspective analysis, MMC-trabeculectomy was associated with higher observed direct medical costs than GATT during available postoperative follow-up. The findings are limited by the retrospective single-centre design, imbalanced groups, nonrandomized surgical selection, no propensity-score matching or inverse-probability weighting, and short follow-up for long-term durability. They should not be interpreted as a long-term cost-utility analysis or causal evidence of economic superiority.
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