Budget impact analysis of the XEN®63 for the treatment of primary openangle glaucoma in Spain | Archivos de la Sociedad Española de Oftalmología (English Edition)

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"apellidos" => "Uría Mundo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Clinic, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "AbbVie Spain, S.L.U" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Former AbbVie employee" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Market Access Area, Pharmalex Spain, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2338 "Ancho" => 3250 "Tamanyo" => 390330 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Candidate target population for XEN®63. POAG: primary open-angle glaucoma Source: 1. INE<a class="elsevierStyleCrossRef" href="#bib0115">23</a>; 2. Antón et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>; 3. EGS<a class="elsevierStyleCrossRef" href="#bib0010">2</a>; 4. Stein et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>; 5. Lorenz et al.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>; 6. Allergan. Internal data.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>" ] ] ] "textoCompleto" => "IntroductionPrimary open-angle glaucoma (POAG) is the most common subtype of glaucoma, with a prevalence in Spain of 2.1% in the population over 40 years of age.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It is a chronic progressive neuropathy characterised by an alteration or sustained increase in intraocular pressure (IOP) due to an obstruction of the aqueous humour drainage channels that leads to irreversible damage to the optic nerve, causing progressive loss of vision leading to preventable irreversible blindness.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Treatments aim to extend the years of useful life of vision, although current management can only prevent the progression of the disease and delay the deterioration of the visual field by reducing IOP. The first therapeutic approach is topical formulas<a class="elsevierStyleCrossRef" href="#bib0010">2</a>, but for many patients they are not sufficient to control the disease<a class="elsevierStyleCrossRef" href="#bib0015">3</a>, leading to progressive loss of visual field with the increase in the number of active ingredients in the treatment, increasing the risk of adverse effects, tolerance and compliance issues.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Due to physical or psychological comorbidities or lifestyle issues, other patients are not able to correctly administer their treatment or do not wish to rely on chronic treatment.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Surgical approach is usually the treatment option after pharmacological and/or laser failure, when there is poor control, allergies or intolerance. The surgical gold standard is trabeculectomy, a penetrating filtrating surgery that effectively reduces IOP, although its complications and associated adverse effects have led to a search for new surgeries that could improve its safety profile such as non-penetrating deep sclerectomy (NPDS), conventional glaucoma drainage devices (GDD) such as the Ahmed valve, or more recently microincisional surgical techniques.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>According to the latest European Guidelines, MIGS (minimally invasive glaucoma surgery) would be considered only those ab-internal techniques that do not form a conjunctival filtration bleb, such as iStent inject®, generally with modest IOP reductions. Techniques that require manipulation of the conjunctiva to generate the bleb cannot be considered minimally invasive and are referred to as minimally penetrating glaucoma surgery (MPGS) such as XEN® and PRESERFLO®, with higher IOP lowering and for a wider patient profile.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>MIGS/MPGS have a better safety profile compared to trabeculectomy and other filtering surgeries.<a class="elsevierStyleCrossRefs" href="#bib0035">7–9</a> When topical treatments are not an option, these alternatives would allow delaying the move to more invasive surgery, without jeopardising their potential success by sparing the conjunctiva.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> In fact, by helping to reduce the burden of topical treatment that is deleterious to the ocular surface, these alternatives could reduce rates of bleeding and fibrosis.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Glaucoma and cataracts frequently coexist, as the prevalence of both diseases increases with age.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Phacoemulsification alone is not recommended as an intervention for the management of POAG as it offers limited benefit in reducing IOP.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The combination of MPGS/MIGS devices and phacoemulsification has been shown to be similar or more effective in lowering IOP compared to phacoemulsification alone, potentially minimising the additional risk of a second surgery and shortening recovery times.<a class="elsevierStyleCrossRefs" href="#bib0060">12–15</a>The XEN® 63 implant is indicated for IOP reduction in patients with POAG whose previous treatments were ineffective<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and can be used alone or in combination with phacoemulsification.<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> It is an MPGS that uses the subconjunctival space as a drainage mechanism through an ab interno approach, being very minimally invasive by maintaining the integrity of the conjunctiva.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a>The introduction of a new therapeutic alternative for the management of a given pathology and population requires tools that allow decision-makers to assess its economic impact on the healthcare budget. For this reason, in the decision-making processes of the National Health System (NHS), budget impact (BI) models are commonly used.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a>The aim of the present study was to evaluate the economic impact for the Spanish NHS after the introduction of XEN®63 to replace XEN®45 (a similar implant but with a smaller internal diameter [45 μm]), in the surgical treatment of POAG with or without cataract in patients who did not respond to pharmacological or laser treatment.Materials and methodsA BI model was developed in Microsoft Excel 2016 to assess the economic consequences associated with the use of XEN®63 as a complete replacement for the previous model XEN®45 in the surgical treatment of POAG in Spain. A timeline of one year was defined to simplify the calculation and to take into account temporal stability of the use of XEN®63 and the other alternatives in subsequent years.The perspective of the analysis was that of the NHS. All parameters used in the model (target population, comparator treatments, market shares, resource use and complications) were validated and agreed by a panel of experts composed of four ophthalmologists specialised in the surgical treatment of glaucoma.The target population was estimated on the basis of the main candidates for treatment with XEN®63<a class="elsevierStyleCrossRef" href="#bib0080">16</a>, who were unresponsive POAG patients and progressed to surgery after 2 or 3 topical treatments. To this end, the Spanish population aged 40–90 years<a class="elsevierStyleCrossRef" href="#bib0115">23</a> diagnosed with POAG using Spanish prevalence data.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Of these, the percentage of patients with 2 or more topical preparations progressing to surgery was considered.<a class="elsevierStyleCrossRefs" href="#bib0120">24–26</a>To estimate the BI associated with XEN®63, two scenarios were compared: current scenario (before commercialisation of XEN®63) and potential scenario (replacement of XEN®45 by XEN®63, after becoming available). The therapeutic alternatives evaluated correspond to those used in Spanish clinical practice based on the results of a recent market study conducted with 80 glaucomatologists.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> The following comparators were considered: trabeculectomy, NPDS, Ahmed valve (AJL Ophtalmic), iStent inject® (GLAUKOS), Preserflo® microshunt (SANTEN) and XEN®45 (ALLERGAN). For each surgical procedure considered, the possibility of performing the procedure alone for POAG or in conjunction with phacoemulsification was included. Following the introduction of XEN®63 on the Spanish market, it is assumed that during the first year it will progressively replace XEN®45 until its withdrawal from the market.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the different alternatives considered and their distribution for the different analysis scenarios. The current distribution of potential comparators was estimated based on market research<a class="elsevierStyleCrossRef" href="#bib0135">27</a> and expert consultation. In the potential scenario, the distribution of comparator treatments and the sales forecast for XEN®63 is the result of Allergan's internal estimates.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The following direct cost categories were considered: acquisition costs of the implanted devices, surgical intervention costs and associated costs (ophthalmological follow-up visits, additional post-surgery procedures and management of complications) during the first year after the surgery. The number of follow-up visits and the frequency of post-surgery procedures and complications were obtained from literature data<a class="elsevierStyleCrossRef" href="#bib0140">28</a> and clinical expert opinion based on the current clinical practice of these patients (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Unit costs for use of resources were obtained from the ESALUD database and those for implants were reviewed with the expert panel<a class="elsevierStyleCrossRef" href="#bib0145">29</a> database and those for implants were reviewed with the expert panel. All costs are expressed in 2021 euros, where necessary costs from earlier periods were updated according to the consumer price index accumulated from the publication of the cost until 31 December 2020 (<a class="elsevierStyleCrossRef" href="#sect0110">Table 1S</a>).Costs for visits were calculated by multiplying the number of visits by the unit cost of each. Costs for additional post-surgery procedures and complication management were calculated by multiplying the frequency of use by the corresponding unit cost. Due to the lack of specific costs for interventions combined with phacoemulsification, the cost of the main intervention and 50% of the cost of phacoemulsification were assumed.ResultsThe target population for the analysis (patients potentially eligible for specific treatment for POAG) was estimated at 25,718 patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the segmented results for the types of costs considered in the analysis. For the estimated target population, the results of the analysis show that in patients with POAG with or without cataracts, the total cost without considering XEN®63 (current scenario), was estimated at €85,881,517 for the first year of the analysis, translated into an annual cost of €3,339 per patient. Considering the scenario in which XEN®63 (replacing XEN®45) is introduced in 24% of patients (potential scenario), the total cost of the scenario drops to €83,311,780, which translated to €3,239 per patient (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The impact results show that the introduction of the XEN implant® 63 as a surgical alternative to POAG is associated with a potential total saving of €2,569,737 (−3%) for the PHS, derived from savings in implant and procedure costs (−€423.120; −0.7%), follow-up visits (−777,407€; −4.5%), additional procedures (−1,048,145€, −20.6%) and post-surgery complications (−321,065€, −14.2%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b).DiscussionThe present study estimated the potential financial impact to the Spanish PHS of introducing XEN®63 as a surgical alternative in the treatment of cataract and non-cataract POAG in patients whose previous treatments were ineffective. Based on the assumptions and assumptions described, it was estimated that its introduction would generate potential savings of €2,569,737 one year after its introduction.Glaucoma and the resulting progressive visual impairment are associated with a high socio-economic burden due to the chronic management of the disease and its implications, giving rise to direct and indirect costs.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> In addition, in patients with blindness secondary to glaucoma, direct non-health costs (rehabilitation, transport, guide dogs, modifications/home care) must be considered, which can be up to 11% due to rehabilitation and 77% due to the cost of home care.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> Therefore, the addition of therapeutic steps or reinforcement of existing ones with new alternatives that are effective in delaying glaucoma progression, enabling fewer complications and allowing for easy post-operative management, could reduce the overall cost or economic burden of the disease<a class="elsevierStyleCrossRef" href="#bib0160">32</a> by improving the management of these patients.Conventional filtrating surgeries are very effective in reducing IOP in POAG despite being associated with potential post-surgical complications and requiring significant post-operative management.<a class="elsevierStyleCrossRef" href="#bib0165">33</a> Compared to these, MIGS/MPGS is less invasive, reduces the use of topical medication and improves the safety profile.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> They may also be an alternative before more invasive surgeries in patients unsuitable for topical treatment.Although the evidence for XEN®63 is still limited, it has demonstrated a sustained reduction in IOP and topical medication<a class="elsevierStyleCrossRefs" href="#bib0090">18,35,36</a> while preserving the conjunctiva and avoiding scar formation, preserving the possibility of future interventions and allowing faster recovery and less impact on patient quality of life.<a class="elsevierStyleCrossRefs" href="#bib0180">36–39</a> Its design allows greater control of post-surgical hypotony which, when it occurs, usually resolves spontaneously.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> The operating time is approximately 10 min, significantly reducing the surgical time compared to most traditional or DDG surgeries.<a class="elsevierStyleCrossRefs" href="#bib0045">9,19</a> On the other hand, MPGS such as XEN®63 have faster learning curves than traditional surgeries<a class="elsevierStyleCrossRef" href="#bib0200">40</a> and given previous experience with XEN®45, it is not expected that clinicians will require additional learning time with XEN®63. Its implementation requires a technique that is accessible for all glaucoma ophthalmologists.<a class="elsevierStyleCrossRefs" href="#bib0085">17,40</a> The learning and skill improvement has been described as more favourable than other techniques (trabeculectomy, Ahmed valve or iStent®).<a class="elsevierStyleCrossRef" href="#bib0185">37</a> This would allow rapid inclusion and standardisation in ophthalmological departments.Therefore, compared to conventional surgeries, the faster and minimally invasive nature of the XEN®63 procedure is associated with a lower rate of complications and post-operative procedures<a class="elsevierStyleCrossRefs" href="#bib0185">37,41</a>, potentially requiring fewer routine follow-up visits and associated with less intense post-operative management, in frequency and complexity, simplifying the procedure and avoiding greater risks to the usually elderly patients.Glaucoma is the second most common cause of blindness after cataracts, and the coexistence of both pathologies increases with age.<a class="elsevierStyleCrossRefs" href="#bib0010">2,12</a> Given that both are widespread in the elderly population, it is necessary to plan the treatment of cataract while dealing with glaucoma as a co-morbidity and viceversa.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> Moreover, according to a recent study, compared to phacoemulsification alone, combined surgery appears to be more cost-effective, mitigating the additional investment of the implant.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> Implantation of XEN®63 together with phacoemulsification would prolong the procedure by a few minutes and may offer an economic advantage, as the incremental costs of performing both procedures would be minimal from a hospital perspective and could potentially reduce waiting lists in ophthalmic departments.Treatment of POAG should aim to reduce IOP while preserving patient quality of life at a sustainable cost to the healthcare system.<a class="elsevierStyleCrossRefs" href="#bib0010">2,43</a> Although many studies have demonstrated the efficacy of MIGS/MPGS, there is still little economic evidence on their implantation in patients with POAG with or without cataract.<a class="elsevierStyleCrossRefs" href="#bib0200">40,44</a> However, a previous study performed with XEN®45 showed that its introduction generated potential savings for the Spanish PHS compared to other interventions (trabeculectomy, NPDS, EXPRESS® and iStent®).<a class="elsevierStyleCrossRef" href="#bib0140">28</a> The results of this study indicate that the incorporation of XEN®63 in the surgical management of POAG could be associated with potential savings from fewer follow-up visits, lower complication rates and additional post-surgical procedures than conventional filtering surgeries or other MIGS/MPGS. Furthermore, the lower cost of the procedure compared to other alternatives allows XEN®63 to be presented as a viable alternative to be incorporated into healthcare services.The present study was not free of limitations. On the one hand, the number of experts on the panel (n = 4) could limit the representativeness at national level in the agreed consensuses. However, a recent study of 80 glaucomatologists in the Spanish public sector was used to cover the management of the pathology throughout the Spanish territory.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> On the other hand, given the lack of published literature on the clinical practice and use of resources associated with the surgical management of POAG in Spain, several hypotheses were formulated through expert opinion and a recent market analysis covering the national healthcare environment.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> This study aims to serve at least as an illustrative example of the potential use of resources and current surgical techniques employed in the treatment of POAG in Spain, being aware of the possible variability in the total costs of the interventions according to the type of hospital, derived from the partial cost referred to the acquisition of the devices in these centres.Further studies will be required to assess the longer-term impact of the introduction of XEN®63 in the surgical management of POAG in patients with or without cataract whose previous treatments have failed.ConclusionsThe inclusion of XEN®63 as a surgical treatment for refractory POAG could represent an economic saving for the PHS as it is an alternative that, despite the limitations described, can satisfy the unmet need for interventions with a safety profile associated with fewer surgical complications, at an affordable cost, reducing surgical time and the need for additional procedures.FundingAbbVie StatementThe design, conduct of the project and financial support for the study has been provided by AbbVie. AbbVie was involved in the interpretation of the data, review and approval of the publication. No honoraria or payments were made for authorship.Allergan acquisition statementOn 8 May 2020 AbbVie completed its acquisition of Allergan, which is now part of AbbVie.Conflict of interestJorge Vila, Esperanza Gutiérrez, José María Martínez de la Casa and Elena Millá declare that they do not have any conflict of interest related to this publication.Cristina de Miguel, Rosa Palomino and Estefanía Uría are full-time employees of Pharmalex. Pharmalex has received financial support from AbbVie for technical advice in the development of XEN projects. Pharmalex employees on an individual basis or Pharmalex on a corporate level have not received any financial compensation from AbbVie for their participation as authors of this article.Julia Salvador is a former AbbVie employee and Almudena Asorey is an AbbVie employee.Asorey is an employee of AbbVie, and both may own AbbVie shares." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1829009" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1594586" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1829010" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1594587" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Funding" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "AbbVie Statement" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Allergan acquisition statement" ] ] ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-05-04" "fechaAceptado" => "2022-09-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1594586" "palabras" => array:5 [ 0 => "Primary open angle glaucoma" 1 => "MIGS" 2 => "Budget impact analysis" 3 => "Cataracts" 4 => "Surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1594587" "palabras" => array:5 [ 0 => "Glaucoma primario de ángulo abierto" 1 => "MIGS" 2 => "Análisis de impacto presupuestario" 3 => "Cataratas" 4 => "Cirugía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveTo evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methodsA budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€ 2021) were obtained from the ESALUD database. ResultsThe inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−€423,120; −0.7%), follow-up visits (−€777,407; −4.5%), additional procedures (−€1,048,145; −20.6%) and post-surgery complications (−€321,065; −14.2%). ConclusionsThe incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoEvaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodosSe diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de 1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones post-cirugía, se emplearon datos de la literatura y se validaron con un panel de 4 expertos. Los costes unitarios (€ del 2021) se obtuvieron de la base de datos ESALUD. ResultadosLa inclusión de XEN®63 podría generar un ahorro de 2.569.737€ tras un año desde su introducción, derivado del ahorro en el coste del implante y procedimiento (-423.120€; -0,7%), visitas de seguimiento (-777.407€; -4,5%), procedimientos adicionales (-1.048.145€; -20,6%) y complicaciones post-cirugía (-321.065€; -14,2%). ConclusionesLa incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "Additional material to this article can be found in its electronic version available at https://doi.org/10.1016/j.oftal.2022.09.004." "titulo" => "Appendix. Additional material" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2338 "Ancho" => 3250 "Tamanyo" => 390330 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Candidate target population for XEN®63. POAG: primary open-angle glaucoma Source: 1. INE<a class="elsevierStyleCrossRef" href="#bib0115">23</a>; 2. Antón et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>; 3. EGS<a class="elsevierStyleCrossRef" href="#bib0010">2</a>; 4. Stein et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>; 5. Lorenz et al.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>; 6. Allergan. Internal data.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3902 "Ancho" => 3083 "Tamanyo" => 379825 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Budgetary impact results. a) Total cost and budgetary impact. b) Cost and budgetary impact broken down by category." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NPDS, non-penetrating deep sclerectomy.Source: Expert consultation and Allergan.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Treatments</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Current scenario (without XEN®63)</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Potential scenario (with XEN®63)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trabeculectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3806 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3086 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trabeculectomy + cataract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5709 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5144 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPDS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3292 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2829 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPDS + cataract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4938 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4681 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preserflo® microshunt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preserflo® microshunt + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iStent inject® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">309 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iStent inject® + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">772 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1517 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®45 + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3060 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ahmed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1492 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1080 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ahmed + cataract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">309 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2572 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®63 + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3601 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Market distribution in the scenarios without and with XEN®63." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NPDS, non-perforating deep sclerectomySource: expert consultation and Martínez de la Casa et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Intervention</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Number of specialist visits</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency of additional procedures</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency of post-surgery complications</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bleb revision \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Removing sutures \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resuturas \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Goniopuncture \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hyphema (in the operating theatre) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Choroidal detachment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Endothelial contact \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Atalamia \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trabeculectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trabeculectomy + cataract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPDS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPDS + cataract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preserflo® microshunt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preserflo® microshunt + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iStent inject® \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iStent inject® + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®45 + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ahmed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8,5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ahmed + cataract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8,5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">XEN®63 + cataracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Use of resources and complications associated with the intervention in the first year after surgery." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Current scenario (without XEN®63) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Potential scenario (with XEN®63) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of implants and procedures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61,264,332 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60,841,212 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of follow-up visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17,264,632 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16,487,225 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of additional procedures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,098,717 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,050,571 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bleb revision cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,255,976 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3,288,935 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of suture removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257,882 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">224,582 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">149,962 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">137,730 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of goniopuncture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">434,896 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">399,324 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of post-surgery complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2,253,836 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,932,771 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of hyphema (in operating theatre) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">396,530 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">331,643 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of choroidal detachment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">261,463 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">213,272 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Endothelial contact cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">163,408 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">173,179 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cost of athalamia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,432,435 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,214,677 € \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85,881,517 € \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83,311,780 € \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Total and itemised costs [euros] for current and potential scenarios." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of primary open-angle glaucoma in a Spanish population: The Segovia study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. 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Budget impact analysis of the XEN®63 for the treatment of primary openangle glaucoma in Spain

Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España

J. Vila Arteagaa,

Corresponding author

jorgevilaarteaga@gmail.com

Corresponding author.

, E. Gutierrez Díazb, J.M. Martínez de la Casac, E. Millá Griñód, A. Asorey Garcíae, J. Salvador Alepuzf, C. de Miguel Gonzálezg, R. Palomino Menesesg, E. Uría Mundog

a Hospital Universitario y Politécnico La Fe, Valencia, Spain

b Hospital Universitario 12 de Octubre, Madrid, Spain

c Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain

d Hospital Clinic, Barcelona, Spain

e AbbVie Spain, S.L.U

f Former AbbVie employee

g Market Access Area, Pharmalex Spain, Barcelona, Spain

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although current management can only prevent the progression of the disease and delay the deterioration of the visual field by reducing IOP&#46; The first therapeutic approach is topical formulas<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; but for many patients they are not sufficient to control the disease<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; leading to progressive loss of visual field with the increase in the number of active ingredients in the treatment&#44; increasing the risk of adverse effects&#44; tolerance and compliance issues&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Due to physical or psychological comorbidities or lifestyle issues&#44; other patients are not able to correctly administer their treatment or do not wish to rely on chronic treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Surgical approach is usually the treatment option after pharmacological and&#47;or laser failure&#44; when there is poor control&#44; allergies or intolerance&#46; The surgical <span class="elsevierStyleItalic">gold standard</span> is trabeculectomy&#44; a penetrating filtrating surgery that effectively reduces IOP&#44; although its complications and associated adverse effects have led to a search for new surgeries that could improve its safety profile such as non-penetrating deep sclerectomy &#40;NPDS&#41;&#44; conventional glaucoma drainage devices &#40;GDD&#41; such as the Ahmed valve&#44; or more recently microincisional surgical techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">According to the latest European Guidelines&#44; MIGS &#40;<span class="elsevierStyleItalic">minimally invasive glaucoma surgery</span>&#41; would be considered only those <span class="elsevierStyleItalic">ab-internal</span> techniques that do not form a conjunctival filtration bleb&#44; such as iStent inject&#174;&#44; generally with modest IOP reductions&#46; Techniques that require manipulation of the conjunctiva to generate the bleb cannot be considered minimally invasive and are referred to as minimally penetrating glaucoma surgery &#40;MPGS&#41; such as XEN&#174; and PRESERFLO&#174;&#44; with higher IOP lowering and for a wider patient profile&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">MIGS&#47;MPGS have a better safety profile compared to trabeculectomy and other filtering surgeries&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> When topical treatments are not an option&#44; these alternatives would allow delaying the move to more invasive surgery&#44; without jeopardising their potential success by sparing the conjunctiva&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In fact&#44; by helping to reduce the burden of topical treatment that is deleterious to the ocular surface&#44; these alternatives could reduce rates of bleeding and fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Glaucoma and cataracts frequently coexist&#44; as the prevalence of both diseases increases with age&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Phacoemulsification alone is not recommended as an intervention for the management of POAG as it offers limited benefit in reducing IOP&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The combination of MPGS&#47;MIGS devices and phacoemulsification has been shown to be similar or more effective in lowering IOP compared to phacoemulsification alone&#44; potentially minimising the additional risk of a second surgery and shortening recovery times&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The XEN&#174; 63 implant is indicated for IOP reduction in patients with POAG whose previous treatments were ineffective<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and can be used alone or in combination with phacoemulsification&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> It is an MPGS that uses the subconjunctival space as a drainage mechanism through an <span class="elsevierStyleItalic">ab interno</span> approach&#44; being very minimally invasive by maintaining the integrity of the conjunctiva&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The introduction of a new therapeutic alternative for the management of a given pathology and population requires tools that allow decision-makers to assess its economic impact on the healthcare budget&#46; For this reason&#44; in the decision-making processes of the National Health System &#40;NHS&#41;&#44; budget impact &#40;BI&#41; models are commonly used&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of the present study was to evaluate the economic impact for the Spanish NHS after the introduction of XEN&#174;63 to replace XEN&#174;45 &#40;a similar implant but with a smaller internal diameter &#91;45 &#956;m&#93;&#41;&#44; in the surgical treatment of POAG with or without cataract in patients who did not respond to pharmacological or laser treatment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">A BI model was developed in <span class="elsevierStyleItalic">Microsoft Excel 2016</span> to assess the economic consequences associated with the use of XEN&#174;63 as a complete replacement for the previous model XEN&#174;45 in the surgical treatment of POAG in Spain&#46; A timeline of one year was defined to simplify the calculation and to take into account temporal stability of the use of XEN&#174;63 and the other alternatives in subsequent years&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The perspective of the analysis was that of the NHS&#46; All parameters used in the model &#40;target population&#44; comparator treatments&#44; market shares&#44; resource use and complications&#41; were validated and agreed by a panel of experts composed of four ophthalmologists specialised in the surgical treatment of glaucoma&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The target population was estimated on the basis of the main candidates for treatment with XEN&#174;63<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#44; who were unresponsive POAG patients and progressed to surgery after 2 or 3 topical treatments&#46; To this end&#44; the Spanish population aged 40&#8211;90 years<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> diagnosed with POAG using Spanish prevalence data&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Of these&#44; the percentage of patients with 2 or more topical preparations progressing to surgery was considered&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To estimate the BI associated with XEN&#174;63&#44; two scenarios were compared&#58; current scenario &#40;before commercialisation of XEN&#174;63&#41; and potential scenario &#40;replacement of XEN&#174;45 by XEN&#174;63&#44; after becoming available&#41;&#46; The therapeutic alternatives evaluated correspond to those used in Spanish clinical practice based on the results of a recent market study conducted with 80 glaucomatologists&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The following comparators were considered&#58; trabeculectomy&#44; NPDS&#44; Ahmed valve &#40;AJL Ophtalmic&#41;&#44; iStent inject&#174; &#40;GLAUKOS&#41;&#44; Preserflo&#174; microshunt &#40;SANTEN&#41; and XEN&#174;45 &#40;ALLERGAN&#41;&#46; For each surgical procedure considered&#44; the possibility of performing the procedure alone for POAG or in conjunction with phacoemulsification was included&#46; Following the introduction of XEN&#174;63 on the Spanish market&#44; it is assumed that during the first year it will progressively replace XEN&#174;45 until its withdrawal from the market&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the different alternatives considered and their distribution for the different analysis scenarios&#46; The current distribution of potential comparators was estimated based on market research<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and expert consultation&#46; In the potential scenario&#44; the distribution of comparator treatments and the sales forecast for XEN&#174;63 is the result of Allergan&#39;s internal estimates&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The following direct cost categories were considered&#58; acquisition costs of the implanted devices&#44; surgical intervention costs and associated costs &#40;ophthalmological follow-up visits&#44; additional post-surgery procedures and management of complications&#41; during the first year after the surgery&#46; The number of follow-up visits and the frequency of post-surgery procedures and complications were obtained from literature data<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> and clinical expert opinion based on the current clinical practice of these patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Unit costs for use of resources were obtained from the ESALUD database and those for implants were reviewed with the expert panel<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> database and those for implants were reviewed with the expert panel&#46; All costs are expressed in 2021 euros&#44; where necessary costs from earlier periods were updated according to the consumer price index accumulated from the publication of the cost until 31 December 2020 &#40;<a class="elsevierStyleCrossRef" href="#sect0110">Table 1S</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Costs for visits were calculated by multiplying the number of visits by the unit cost of each&#46; Costs for additional post-surgery procedures and complication management were calculated by multiplying the frequency of use by the corresponding unit cost&#46; Due to the lack of specific costs for interventions combined with phacoemulsification&#44; the cost of the main intervention and 50&#37; of the cost of phacoemulsification were assumed&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The target population for the analysis &#40;patients potentially eligible for specific treatment for POAG&#41; was estimated at 25&#44;718 patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the segmented results for the types of costs considered in the analysis&#46; For the estimated target population&#44; the results of the analysis show that in patients with POAG with or without cataracts&#44; the total cost without considering XEN&#174;63 &#40;current scenario&#41;&#44; was estimated at &#8364;85&#44;881&#44;517 for the first year of the analysis&#44; translated into an annual cost of &#8364;3&#44;339 per patient&#46; Considering the scenario in which XEN&#174;63 &#40;replacing XEN&#174;45&#41; is introduced in 24&#37; of patients &#40;potential scenario&#41;&#44; the total cost of the scenario drops to &#8364;83&#44;311&#44;780&#44; which translated to &#8364;3&#44;239 per patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The impact results show that the introduction of the XEN implant&#174; 63 as a surgical alternative to POAG is associated with a potential total saving of &#8364;2&#44;569&#44;737 &#40;&#8722;3&#37;&#41; for the PHS&#44; derived from savings in implant and procedure costs &#40;&#8722;&#8364;423&#46;120&#59; &#8722;0&#46;7&#37;&#41;&#44; follow-up visits &#40;&#8722;777&#44;407&#8364;&#59; &#8722;4&#46;5&#37;&#41;&#44; additional procedures &#40;&#8722;1&#44;048&#44;145&#8364;&#44; &#8722;20&#46;6&#37;&#41; and post-surgery complications &#40;&#8722;321&#44;065&#8364;&#44; &#8722;14&#46;2&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The present study estimated the potential financial impact to the Spanish PHS of introducing XEN&#174;63 as a surgical alternative in the treatment of cataract and non-cataract POAG in patients whose previous treatments were ineffective&#46; Based on the assumptions and assumptions described&#44; it was estimated that its introduction would generate potential savings of &#8364;2&#44;569&#44;737 one year after its introduction&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Glaucoma and the resulting progressive visual impairment are associated with a high socio-economic burden due to the chronic management of the disease and its implications&#44; giving rise to direct and indirect costs&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> In addition&#44; in patients with blindness secondary to glaucoma&#44; direct non-health costs &#40;rehabilitation&#44; transport&#44; guide dogs&#44; modifications&#47;home care&#41; must be considered&#44; which can be up to 11&#37; due to rehabilitation and 77&#37; due to the cost of home care&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Therefore&#44; the addition of therapeutic steps or reinforcement of existing ones with new alternatives that are effective in delaying glaucoma progression&#44; enabling fewer complications and allowing for easy post-operative management&#44; could reduce the overall cost or economic burden of the disease<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> by improving the management of these patients&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Conventional filtrating surgeries are very effective in reducing IOP in POAG despite being associated with potential post-surgical complications and requiring significant post-operative management&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Compared to these&#44; MIGS&#47;MPGS is less invasive&#44; reduces the use of topical medication and improves the safety profile&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> They may also be an alternative before more invasive surgeries in patients unsuitable for topical treatment&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although the evidence for XEN&#174;63 is still limited&#44; it has demonstrated a sustained reduction in IOP and topical medication<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;35&#44;36</span></a> while preserving the conjunctiva and avoiding scar formation&#44; preserving the possibility of future interventions and allowing faster recovery and less impact on patient quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#8211;39</span></a> Its design allows greater control of post-surgical hypotony which&#44; when it occurs&#44; usually resolves spontaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> The operating time is approximately 10 min&#44; significantly reducing the surgical time compared to most traditional or DDG surgeries&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;19</span></a> On the other hand&#44; MPGS such as XEN&#174;63 have faster learning curves than traditional surgeries<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> and given previous experience with XEN&#174;45&#44; it is not expected that clinicians will require additional learning time with XEN&#174;63&#46; Its implementation requires a technique that is accessible for all glaucoma ophthalmologists&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;40</span></a> The learning and skill improvement has been described as more favourable than other techniques &#40;trabeculectomy&#44; Ahmed valve or iStent&#174;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> This would allow rapid inclusion and standardisation in ophthalmological departments&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Therefore&#44; compared to conventional surgeries&#44; the faster and minimally invasive nature of the XEN&#174;63 procedure is associated with a lower rate of complications and post-operative procedures<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;41</span></a>&#44; potentially requiring fewer routine follow-up visits and associated with less intense post-operative management&#44; in frequency and complexity&#44; simplifying the procedure and avoiding greater risks to the usually elderly patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Glaucoma is the second most common cause of blindness after cataracts&#44; and the coexistence of both pathologies increases with age&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;12</span></a> Given that both are widespread in the elderly population&#44; it is necessary to plan the treatment of cataract while dealing with glaucoma as a co-morbidity and viceversa&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Moreover&#44; according to a recent study&#44; compared to phacoemulsification alone&#44; combined surgery appears to be more cost-effective&#44; mitigating the additional investment of the implant&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> Implantation of XEN&#174;63 together with phacoemulsification would prolong the procedure by a few minutes and may offer an economic advantage&#44; as the incremental costs of performing both procedures would be minimal from a hospital perspective and could potentially reduce waiting lists in ophthalmic departments&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Treatment of POAG should aim to reduce IOP while preserving patient quality of life at a sustainable cost to the healthcare system&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;43</span></a> Although many studies have demonstrated the efficacy of MIGS&#47;MPGS&#44; there is still little economic evidence on their implantation in patients with POAG with or without cataract&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;44</span></a> However&#44; a previous study performed with XEN&#174;45 showed that its introduction generated potential savings for the Spanish PHS compared to other interventions &#40;trabeculectomy&#44; NPDS&#44; EXPRESS&#174; and iStent&#174;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The results of this study indicate that the incorporation of XEN&#174;63 in the surgical management of POAG could be associated with potential savings from fewer follow-up visits&#44; lower complication rates and additional post-surgical procedures than conventional filtering surgeries or other MIGS&#47;MPGS&#46; Furthermore&#44; the lower cost of the procedure compared to other alternatives allows XEN&#174;63 to be presented as a viable alternative to be incorporated into healthcare services&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The present study was not free of limitations&#46; On the one hand&#44; the number of experts on the panel &#40;<span class="elsevierStyleItalic">n</span> &#61; 4&#41; could limit the representativeness at national level in the agreed consensuses&#46; However&#44; a recent study of 80 glaucomatologists in the Spanish public sector was used to cover the management of the pathology throughout the Spanish territory&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> On the other hand&#44; given the lack of published literature on the clinical practice and use of resources associated with the surgical management of POAG in Spain&#44; several hypotheses were formulated through expert opinion and a recent market analysis covering the national healthcare environment&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> This study aims to serve at least as an illustrative example of the potential use of resources and current surgical techniques employed in the treatment of POAG in Spain&#44; being aware of the possible variability in the total costs of the interventions according to the type of hospital&#44; derived from the partial cost referred to the acquisition of the devices in these centres&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Further studies will be required to assess the longer-term impact of the introduction of XEN&#174;63 in the surgical management of POAG in patients with or without cataract whose previous treatments have failed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">The inclusion of XEN&#174;63 as a surgical treatment for refractory POAG could represent an economic saving for the PHS as it is an alternative that&#44; despite the limitations described&#44; can satisfy the unmet need for interventions with a safety profile associated with fewer surgical complications&#44; at an affordable cost&#44; reducing surgical time and the need for additional procedures&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">AbbVie Statement</span><p id="par0150" class="elsevierStylePara elsevierViewall">The design&#44; conduct of the project and financial support for the study has been provided by AbbVie&#46; AbbVie was involved in the interpretation of the data&#44; review and approval of the publication&#46; No honoraria or payments were made for authorship&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Allergan acquisition statement</span><p id="par0155" class="elsevierStylePara elsevierViewall">On 8 May 2020 AbbVie completed its acquisition of Allergan&#44; which is now part of AbbVie&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">Jorge Vila&#44; Esperanza Guti&#233;rrez&#44; Jos&#233; Mar&#237;a Mart&#237;nez de la Casa and Elena Mill&#225; declare that they do not have any conflict of interest related to this publication&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Cristina de Miguel&#44; Rosa Palomino and Estefan&#237;a Ur&#237;a are full-time employees of Pharmalex&#46; Pharmalex has received financial support from AbbVie for technical advice in the development of XEN projects&#46; Pharmalex employees on an individual basis or Pharmalex on a corporate level have not received any financial compensation from AbbVie for their participation as authors of this article&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Julia Salvador is a former AbbVie employee and Almudena Asorey is an AbbVie employee&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Asorey is an employee of AbbVie&#44; and both may own AbbVie shares&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">To evaluate the economic impact in Spain derived from the introduction of the XEN&#174;63 implant as a surgical alternative in the management of primary open angle glaucoma &#40;POAG&#41; with or without cataract in refractory patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System &#40;NHS&#41;&#44; over a time horizon of 1 year&#46; The comparators considered &#40;trabeculectomy&#44; deep non-penetrating sclerectomy&#44; Ahmed valve&#44; iStent inject&#44; Preserflo&#174; microshunt and XEN&#174;45&#41; correspond to those used in Spanish public clinical practice&#46; For the calculation of the target population&#44; market shares and resource use in terms of follow-up visits&#44; additional procedures and post-surgery complications&#44; data from the literature were used and validated with a panel of 4 experts&#46; Unit costs &#40;&#8364; 2021&#41; were obtained from the ESALUD database&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The inclusion of XEN&#174;63 could generate savings of &#8364;2&#44;569&#44;737 after one year since its introduction&#44; derived from savings in the cost of the implant and procedure &#40;&#8722;&#8364;423&#44;120&#59; &#8722;0&#46;7&#37;&#41;&#44; follow-up visits &#40;&#8722;&#8364;777&#44;407&#59; &#8722;4&#46;5&#37;&#41;&#44; additional procedures &#40;&#8722;&#8364;1&#44;048&#44;145&#59; &#8722;20&#46;6&#37;&#41; and post-surgery complications &#40;&#8722;&#8364;321&#44;065&#59; &#8722;14&#46;2&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The incorporation of XEN63&#174;in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto econ&#243;mico en Espa&#241;a derivado de la introducci&#243;n del implante XEN&#174;63 como alternativa quir&#250;rgica en el manejo del glaucoma primario de &#225;ngulo abierto &#40;GPAA&#41; con o sin cataratas en pacientes refractarios&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un an&#225;lisis de impacto presupuestario para estimar los costes del tratamiento quir&#250;rgico del GPAA desde la perspectiva del Sistema Nacional de Salud &#40;SNS&#41; espa&#241;ol&#44; en un horizonte temporal de 1 a&#241;o&#46; Los comparadores considerados &#40;trabeculectom&#237;a&#44; esclerectom&#237;a profunda no perforante&#44; v&#225;lvula de Ahmed&#44; iStent inject&#174;&#44; Preserflo&#174; microshunt y XEN&#174;45&#41; se corresponden a los empleados en la pr&#225;ctica cl&#237;nica p&#250;blica espa&#241;ola&#46; Para el c&#225;lculo de la poblaci&#243;n diana&#44; cuotas de mercado y uso de recursos en t&#233;rminos de visitas de seguimiento&#44; procedimientos adicionales y complicaciones post-cirug&#237;a&#44; se emplearon datos de la literatura y se validaron con un panel de 4 expertos&#46; Los costes unitarios &#40;&#8364; del 2021&#41; se obtuvieron de la base de datos ESALUD&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La inclusi&#243;n de XEN&#174;63 podr&#237;a generar un ahorro de 2&#46;569&#46;737&#8364; tras un a&#241;o desde su introducci&#243;n&#44; derivado del ahorro en el coste del implante y procedimiento &#40;-423&#46;120&#8364;&#59; -0&#44;7&#37;&#41;&#44; visitas de seguimiento &#40;-777&#46;407&#8364;&#59; -4&#44;5&#37;&#41;&#44; procedimientos adicionales &#40;-1&#46;048&#46;145&#8364;&#59; -20&#44;6&#37;&#41; y complicaciones post-cirug&#237;a &#40;-321&#46;065&#8364;&#59; -14&#44;2&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">La incorporaci&#243;n de XEN&#174;63 en el arsenal quir&#250;rgico para el tratamiento del GPAA refractario con y sin cataratas podr&#237;a generar ahorros para el SNS&#46;</p></span>"
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            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">Additional material to this article can be found in its electronic version available at <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.oftal.2022.09.004">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;oftal&#46;2022&#46;09&#46;004</span>&#46;</p>"
            "titulo" => "Appendix&#46; Additional material"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Candidate target population for XEN&#174;63&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">POAG&#58; primary open-angle glaucoma</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source&#58; 1&#46; INE<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#59; 2&#46; Ant&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#59; 3&#46; EGS<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#59; 4&#46; Stein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#59; 5&#46; Lorenz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#59; 6&#46; Allergan&#46; Internal data&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Budgetary impact results&#46; a&#41; Total cost and budgetary impact&#46; b&#41; Cost and budgetary impact broken down by category&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NPDS&#44; non-penetrating deep sclerectomy&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Expert consultation and Allergan&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p>"
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Treatments</th><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">NPDS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">NPDS &#43; cataract&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">18&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Preserflo&#174; microshunt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Preserflo&#174; microshunt &#43; cataracts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iStent inject&#174;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iStent inject&#174; &#43; cataracts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">772&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">XEN&#174;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">NPDS &#43; cataract&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Preserflo&#174; microshunt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Preserflo&#174; microshunt &#43; cataracts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">iStent inject&#174;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">iStent inject&#174; &#43; cataracts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">XEN&#174;45 &#43; cataracts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ahmed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">XEN&#174;63 &#43; cataracts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Current scenario &#40;without XEN&#174;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Potential scenario &#40;with XEN&#174;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">60&#44;841&#44;212 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cost of follow-up visits</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">17&#44;264&#44;632 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">16&#44;487&#44;225 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cost of additional procedures</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">5&#44;098&#44;717 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">4&#44;050&#44;571 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bleb revision cost&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cost of suture removal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cost of results&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">137&#44;730 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cost of goniopuncture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">434&#44;896 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">399&#44;324 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Cost of post-surgery complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#44;253&#44;836 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">1&#44;932&#44;771 &#8364;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cost of hyphema &#40;in operating theatre&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">396&#44;530 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Cost of choroidal detachment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Endothelial contact cost&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">163&#44;408 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;214&#44;677 &#8364;&nbsp;\t\t\t\t\t\t\n
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