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Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España
Budget impact analysis of the XEN®63 for the treatment of primary open angle glaucoma in Spain
J. Vila Arteagaa,
Autor para correspondencia
jorgevilaarteaga@gmail.com

Autor para correspondencia.
, 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, España
b Hospital Universitario 12 de Octubre, Madrid, España
c Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, España
d Hospital Clínic, Barcelona, España
e AbbVie Spain, S.L.U
f Former AbbVie employee
g Market Access Area, Pharmalex Spain, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El glaucoma primario de &#225;ngulo abierto &#40;GPAA&#41; es el subtipo m&#225;s frecuente de glaucoma&#44; con una prevalencia en Espa&#241;a del 2&#44;1&#37; en la poblaci&#243;n mayor de 40<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a>&#46; Es una neuropat&#237;a cr&#243;nica progresiva caracterizada por una alteraci&#243;n o aumento sostenido de la presi&#243;n intraocular &#40;PIO&#41; debido a una obstrucci&#243;n de los canales de drenaje del humor acuoso que deriva en un da&#241;o irreversible en el nervio &#243;ptico&#44; ocasionando una p&#233;rdida progresiva de visi&#243;n hasta ocasionar ceguera irreversible prevenible<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo del tratamiento es alargar los a&#241;os de vida &#250;til de visi&#243;n&#59; sin embargo&#44; el manejo actual solo permite prevenir el avance de la enfermedad y retrasar el deterioro del campo visual reduciendo la PIO&#46; El primer abordaje terap&#233;utico son las f&#243;rmulas t&#243;picas<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#44; pero para muchos pacientes no son suficientes para controlar la enfermedad<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">3</span></a>&#44; produci&#233;ndose una p&#233;rdida progresiva del campo visual a medida que se incrementa el n&#250;mero de principios activos en su tratamiento&#44; aumentando el riesgo de efectos adversos&#44; problemas de tolerancia y adherencia<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Otros pacientes&#44; debido a comorbilidades f&#237;sicas o ps&#237;quicas o a su estilo de vida&#44; no son capaces de instilarse correctamente el tratamiento o no desean depender de un tratamiento cr&#243;nico<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">6</span></a>&#46; El abordaje quir&#250;rgico suele ser la opci&#243;n de tratamiento tras el fallo farmacol&#243;gico y&#47;o del l&#225;ser&#44; cuando hay un mal control&#44; causan alergias o intolerancia&#46; El <span class="elsevierStyleItalic">gold standard</span> quir&#250;rgico es la trabeculectom&#237;a&#44; una cirug&#237;a filtrante penetrante que reduce eficazmente la PIO&#44; aunque sus complicaciones y sus efectos adversos asociados han derivado en la b&#250;squeda de nuevas cirug&#237;as que pudieran mejorar el perfil de seguridad&#44; como la esclerectom&#237;a profunda no perforante &#40;EPNP&#41;&#44; los dispositivos convencionales de drenaje del glaucoma &#40;DDG&#41;&#44; como la v&#225;lvula de Ahmed&#44; o m&#225;s recientemente las t&#233;cnicas quir&#250;rgicas microincisionales<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seg&#250;n las &#250;ltimas Gu&#237;as Europeas&#44; solo se considerar&#237;an <span class="elsevierStyleItalic">minimally invasive glaucoma surgery</span> &#40;MIGS&#41; aquellas t&#233;cnicas <span class="elsevierStyleItalic">ab interno</span> que no formen ampolla de filtraci&#243;n conjuntival&#44; como iStent inject&#174;&#44; generalmente con bajadas modestas de la PIO&#46; Las t&#233;cnicas cuyo funcionamiento requiere manipular la conjuntiva&#44; gener&#225;ndose la ampolla&#44; no pueden considerarse m&#237;nimamente invasivas y se denominan cirug&#237;as de glaucoma m&#237;nimamente penetrante &#40;<span class="elsevierStyleItalic">minimally penetrating glaucoma surgery</span> &#91;MPGS&#93;&#41;&#44; como XEN&#174; y PRESERFLO&#174;&#44; con una bajada de la PIO superior y para un perfil de paciente m&#225;s amplio<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las MIGS&#47;MPGS presentan un mejor perfil de seguridad comparadas con la trabeculectom&#237;a y otras cirug&#237;as filtrantes<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">7-9</span></a>&#46; Cuando los tratamientos t&#243;picos no son una opci&#243;n&#44; estas alternativas permitir&#237;an retrasar el paso a una cirug&#237;a m&#225;s invasiva&#44; sin perjudicar su potencial &#233;xito al ser respetuosas con la conjuntiva<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">10</span></a>&#46; De hecho&#44; al contribuir reduciendo la carga de tratamiento t&#243;pico que es delet&#233;reo para la superficie ocular&#44; estas alternativas podr&#237;an disminuir las tasas de sangrado y de fibrosis<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Glaucoma y cataratas suelen coexistir frecuentemente&#44; ya que la prevalencia de ambas enfermedades aumenta con la edad<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">12</span></a>&#46; La facoemulsificaci&#243;n por s&#237; sola no se recomienda como intervenci&#243;n para el control del GPAA por ofrecer un beneficio limitado en la reducci&#243;n de la PIO<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#46; La combinaci&#243;n de dispositivos MPGS&#47;MIGS y facoemulsificaci&#243;n ha demostrado ser similar o m&#225;s eficaz en la disminuci&#243;n de la PIO en comparaci&#243;n con la facoemulsificaci&#243;n sola&#44; minimizando potencialmente el riesgo adicional de una segunda cirug&#237;a y acortando los tiempos de recuperaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">12-15</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El implante XEN&#174;63 est&#225; indicado para la reducci&#243;n de la PIO en pacientes con GPAA cuyos tratamientos previos fueron ineficaces<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">16</span></a>&#44; pudiendo emplearse solo o combinado con facoemulsificaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; Se trata de una MPGS que emplea como mecanismo de drenaje el espacio subconjuntival mediante un abordaje <span class="elsevierStyleItalic">ab interno</span>&#44; siendo muy poco invasivo al mantener la integridad de la conjuntiva<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La introducci&#243;n de una nueva alternativa terap&#233;utica para el manejo de una determinada patolog&#237;a y poblaci&#243;n requiere herramientas que permitan a los agentes decisores evaluar su impacto econ&#243;mico en el presupuesto sanitario&#46; Por ello&#44; en los procesos de toma de decisi&#243;n del Sistema Nacional de Salud &#40;SNS&#41; se utilizan habitualmente los modelos de impacto presupuestario &#40;IP&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio fue evaluar el impacto econ&#243;mico para el SNS espa&#241;ol tras la introducci&#243;n de XEN&#174;63 en sustituci&#243;n de XEN&#174;45 &#40;un implante similar pero con un menor di&#225;metro interno &#91;45<span class="elsevierStyleHsp" style=""></span>&#956;m&#93;&#41;&#44; en el tratamiento quir&#250;rgico del GPAA con o sin cataratas en pacientes que no responden al tratamiento farmacol&#243;gico o l&#225;ser&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se elabor&#243; un modelo de IP en Microsoft Excel 2016 para valorar las consecuencias econ&#243;micas asociadas a la utilizaci&#243;n de XEN&#174;63 sustituyendo completamente al modelo anterior XEN&#174;45 en el tratamiento quir&#250;rgico de GPAA en Espa&#241;a&#46; Se defini&#243; un horizonte temporal de un a&#241;o para simplificar el c&#225;lculo y atendiendo a una estabilidad temporal del uso de XEN&#174;63 y de las otras alternativas en a&#241;os posteriores&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La perspectiva del an&#225;lisis fue la del SNS&#46; Todos los par&#225;metros utilizados en el modelo &#40;poblaci&#243;n diana&#44; tratamientos comparadores&#44; cuotas de mercado&#44; uso de recursos y complicaciones&#41; fueron validados y consensuados por un panel de expertos compuesto por cuatro oftalm&#243;logos especializados en el tratamiento quir&#250;rgico del glaucoma&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La poblaci&#243;n diana se estim&#243; en base a los principales candidatos a recibir el tratamiento con XEN&#174;63<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">16</span></a>&#44; pacientes con GPAA que no responden y progresan a cirug&#237;a tras dos o tres tratamientos t&#243;picos&#46; Para ello&#44; se identific&#243; la poblaci&#243;n espa&#241;ola de entre 40 y 90<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a> diagnosticada con GPAA empleando los datos espa&#241;oles de prevalencia<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; De esta&#44; se consider&#243; el porcentaje de pacientes con dos o m&#225;s preparados t&#243;picos que progresaban a cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">24-26</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para estimar el IP asociado a XEN&#174;63 se compararon dos escenarios&#58; escenario actual &#40;antes de comercializar XEN&#174;63&#41; y escenario potencial &#40;sustituci&#243;n de XEN&#174;45 por XEN&#174;63&#44; tras su comercializaci&#243;n&#41;&#46; Las alternativas terap&#233;uticas evaluadas se corresponden a las utilizadas en la pr&#225;ctica cl&#237;nica espa&#241;ola en base a los resultados de un reciente estudio de mercado realizado con 80 glaucomat&#243;logos<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a>&#46; Se consideraron los siguientes comparadores&#58; trabeculectom&#237;a&#44; EPNP&#44; v&#225;lvula de Ahmed &#40;AJL Ophtalmic&#41;&#44; iStent inject&#174; &#40;GLAUKOS&#41;&#44; Preserflo&#174; microshunt &#40;SANTEN&#41; y XEN&#174;45 &#40;ALLERGAN&#41;&#46; Para cada intervenci&#243;n quir&#250;rgica considerada se incluy&#243; la posibilidad de realizar la intervenci&#243;n solo para el GPAA o junto a facoemulsificaci&#243;n&#46; Tras la introducci&#243;n de XEN&#174;63 en el mercado espa&#241;ol&#44; se asume que durante el primer a&#241;o este sustituir&#225; progresivamente a XEN&#174;45 hasta su retirada del mercado&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las distintas alternativas consideradas y su distribuci&#243;n para los diferentes escenarios del an&#225;lisis&#46; La distribuci&#243;n actual de los comparadores potenciales fue estimada en base a un estudio de mercado<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a> y consulta a expertos&#46; En el escenario potencial&#44; la distribuci&#243;n de los tratamientos comparadores y la previsi&#243;n de ventas de XEN&#174;63 es resultado de las estimaciones internas de Allergan&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Se consideraron las siguientes categor&#237;as de costes directos&#58; costes de adquisici&#243;n de los dispositivos implantados&#44; costes de intervenci&#243;n quir&#250;rgica y costes asociados a la intervenci&#243;n quir&#250;rgica &#40;visitas de seguimiento oftalmol&#243;gicas&#44; procedimientos adicionales poscirug&#237;a y manejo de complicaciones&#41; durante el primer a&#241;o tras la intervenci&#243;n&#46; El n&#250;mero de visitas de seguimiento y la frecuencia de procedimientos y complicaciones poscirug&#237;a se obtuvo a partir de datos de la literatura<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">28</span></a> y la opini&#243;n de expertos cl&#237;nicos en base a la pr&#225;ctica cl&#237;nica actual de estos pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Los costes unitarios de uso de recursos se obtuvieron de la base de datos ESALUD<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">29</span></a>&#44; y los de los implantes se revisaron con el panel de expertos&#46; Todos los costes se expresan en euros del a&#241;o 2021&#44; y cuando fueron necesarios los costes de periodos anteriores se actualizaron seg&#250;n el &#237;ndice de precios al consumo acumulado desde la publicaci&#243;n del coste hasta el 31 de diciembre del 2020 &#40;<a class="elsevierStyleCrossRef" href="#sec0055">tabla 1S</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los costes correspondientes a las visitas se calcularon multiplicando el n&#250;mero de visitas por el coste unitario de cada visita&#46; Los costes correspondientes a los procedimientos adicionales poscirug&#237;a y manejo de complicaciones se calcularon multiplicando la frecuencia de uso por el coste unitario correspondiente&#46; Debido a la falta de costes espec&#237;ficos para las intervenciones combinadas con la facoemulsificaci&#243;n&#44; se asumi&#243; el coste de la intervenci&#243;n principal y el 50&#37; del coste de la facoemulsificaci&#243;n&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">La poblaci&#243;n diana para el an&#225;lisis &#40;pacientes potencialmente tributarios de recibir el tratamiento espec&#237;fico para el GPAA&#41; se estim&#243; en 25&#46;718 pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recogen los resultados disgregados para los tipos de costes considerados en el an&#225;lisis&#46; Para la poblaci&#243;n diana estimada&#44; los resultados del an&#225;lisis muestran que en pacientes con GPAA con o sin cataratas el coste total sin considerar XEN&#174;63 &#40;escenario actual&#41; se estim&#243; en 85&#46;881&#46;517<span class="elsevierStyleHsp" style=""></span>&#8364; para el primer a&#241;o del an&#225;lisis&#44; traducido a un coste anual de 3&#46;339<span class="elsevierStyleHsp" style=""></span>&#8364; por paciente&#46; Considerando el escenario en el que se introduce XEN&#174;63 &#40;en sustituci&#243;n de XEN&#174;45&#41; en el 24&#37; de los pacientes &#40;escenario potencial&#41;&#44; el coste total del escenario desciende a 83&#46;311&#46;780<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; lo que se tradujo a 3&#46;239<span class="elsevierStyleHsp" style=""></span>&#8364; por paciente &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 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">Los resultados del impacto muestran que la introducci&#243;n del implante XEN&#174;63 como alternativa quir&#250;rgica del GPAA se asocia a un potencial ahorro total de 2&#46;569&#46;737<span class="elsevierStyleHsp" style=""></span>&#8364; &#40;&#8722;3&#37;&#41; para el SNS&#44; derivado del ahorro en el coste del implante y del procedimiento &#40;&#8722;423&#46;120&#59; &#8722;0&#44;7&#37;&#41;&#44; visitas de seguimiento &#40;&#8722;777&#46;407<span class="elsevierStyleHsp" style=""></span>&#8364;&#59; &#8722;4&#44;5&#37;&#41;&#44; procedimientos adicionales &#40;&#8722;1&#46;048&#46;145<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; &#8722;20&#44;6&#37;&#41; y complicaciones poscirug&#237;a &#40;&#8722;321&#46;065<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; &#8722;14&#44;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">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudio estim&#243; el potencial impacto financiero para el SNS espa&#241;ol derivado de la introducci&#243;n de XEN&#174;63 como alternativa quir&#250;rgica en el tratamiento del GPAA con y sin cataratas en pacientes cuyos tratamientos previos fueron ineficaces&#46; En base a los supuestos y asunciones descritas&#44; se estim&#243; que su introducci&#243;n generar&#237;a un potencial ahorro de 2&#46;569&#46;737<span class="elsevierStyleHsp" style=""></span>&#8364; tras un a&#241;o despu&#233;s de su incorporaci&#243;n&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El glaucoma y la progresiva discapacidad visual resultante se asocian a una elevada carga socioecon&#243;mica debido al manejo cr&#243;nico de la patolog&#237;a y a sus implicaciones&#44; repercutiendo en costes directos e indirectos<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">30</span></a>&#46; Adem&#225;s&#44; en los pacientes con ceguera secundaria al glaucoma se deben considerar los costes directos no sanitarios &#40;rehabilitaci&#243;n&#44; transporte&#44; perros gu&#237;a&#44; modificaciones&#47;atenci&#243;n en el hogar&#41;&#44; que pueden suponer hasta un 11&#37; debido a la rehabilitaci&#243;n y un 77&#37; al coste de la ayuda en el hogar<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">31</span></a>&#46; Por lo tanto&#44; a&#241;adir escalones terap&#233;uticos o reforzar los ya existentes con nuevas alternativas eficaces en el retraso de la progresi&#243;n del glaucoma&#44; que ocasionen menores complicaciones y permitan un f&#225;cil manejo postoperatorio&#44; podr&#237;a reducir el coste global o carga econ&#243;mica de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">32</span></a>&#44; mejorando el abordaje de estos pacientes&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Las cirug&#237;as filtrantes convencionales son muy eficaces en la reducci&#243;n de la PIO en el GPAA&#59; sin embargo&#44; se asocian a posibles complicaciones posquir&#250;rgicas y requieren un tratamiento postoperatorio importante<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">33</span></a>&#46; En comparaci&#243;n con estas&#44; las MIGS&#47;MPGS son menos invasivas&#44; reducen el uso de medicaci&#243;n t&#243;pica y mejoran el perfil de seguridad<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">34</span></a>&#44; pudiendo ser tambi&#233;n una alternativa antes de cirug&#237;as m&#225;s invasivas en pacientes no aptos para el tratamiento t&#243;pico&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Aunque la evidencia de XEN&#174;63 es todav&#237;a limitada&#44; ha demostrado una reducci&#243;n sostenida de la PIO y de la medicaci&#243;n t&#243;pica<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">18&#44;35&#44;36</span></a>&#44; conservando la conjuntiva y evitando la formaci&#243;n de cicatrices&#44; preservando la posibilidad de futuras intervenciones y permitiendo una recuperaci&#243;n m&#225;s r&#225;pida y un menor impacto en la calidad de vida del paciente<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">36-39</span></a>&#46; Su dise&#241;o permite un mayor control de la hipoton&#237;a posquir&#250;rgica&#44; que&#44; cuando se produce&#44; habitualmente se resuelve espont&#225;neamente<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">35</span></a>&#46; El tiempo de intervenci&#243;n es de aproximadamente 10<span class="elsevierStyleHsp" style=""></span>minutos&#44; reduciendo significativamente el tiempo quir&#250;rgico respecto a la mayor&#237;a de cirug&#237;as tradicionales o DDG<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">9&#44;19</span></a>&#46; Por otra parte&#44; los MPGS&#44; como XEN&#174;63&#44; presentan curvas de aprendizaje m&#225;s r&#225;pidas que las cirug&#237;as tradicionales<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">40</span></a>&#44; y dada la experiencia previa con XEN&#174;45&#44; no se espera que los cl&#237;nicos requieran un tiempo adicional de aprendizaje con XEN&#174;63&#46; Su implantaci&#243;n requiere una t&#233;cnica accesible para todos los oftalm&#243;logos especialistas en glaucoma<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">17&#44;40</span></a>&#44; cuyo aprendizaje y mejora de la destreza se ha descrito m&#225;s favorable respecto a otras t&#233;cnicas &#40;trabeculectom&#237;a&#44; v&#225;lvula de Ahmed o iStent&#174;&#41;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">37</span></a>&#44; lo que permitir&#237;a una inclusi&#243;n y una estandarizaci&#243;n r&#225;pidas en los servicios oftalmol&#243;gicos&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por lo tanto&#44; respecto a cirug&#237;as convencionales&#44; la mayor rapidez y la m&#237;nima invasividad del procedimiento con XEN&#174;63 se asocian a una menor tasa de complicaciones y procedimientos postoperatorios<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">37&#44;41</span></a>&#44; requiriendo potencialmente menos visitas de seguimiento rutinarias y asoci&#225;ndose a un manejo posquir&#250;rgico menos intenso&#44; en frecuencia y complejidad&#44; simplificando el procedimiento y evitando riesgos mayores al paciente&#44; normalmente de edad avanzada&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El glaucoma es la segunda causa m&#225;s frecuente de ceguera tras las cataratas&#44; y con la edad aumenta la coexistencia de ambas patolog&#237;as<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">2&#44;12</span></a>&#46; Dado que ambas est&#225;n muy extendidas en la poblaci&#243;n de edad avanzada&#44; es necesario planificar el tratamiento de la catarata al tiempo que se afronta el glaucoma como comorbilidad&#44; y viceversa<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">42</span></a>&#46; Adem&#225;s&#44; de acuerdo a un reciente estudio&#44; en comparaci&#243;n con la facoemulsificaci&#243;n sola&#44; la cirug&#237;a combinada parecer ser m&#225;s coste-efectiva&#44; mitig&#225;ndose la inversi&#243;n adicional del implante<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">43</span></a>&#46; La implantaci&#243;n de XEN&#174;63 junto a facoemulsificaci&#243;n prolongar&#237;a la intervenci&#243;n en unos pocos minutos&#44; pudiendo ofrecer una ventaja a nivel econ&#243;mico&#44; ya que los costes incrementales de realizar ambas intervenciones ser&#237;an m&#237;nimos desde la perspectiva hospitalaria y potencialmente podr&#237;an reducir las listas de espera de los servicios oftalmol&#243;gicos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">El tratamiento del GPAA debe tener como objetivo reducir la PIO preservando la calidad de vida del paciente a un coste sostenible para el sistema sanitario<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">2&#44;43</span></a>&#46; Aunque muchos estudios han demostrado la eficacia de los MIGS&#47;MPGS&#44; a&#250;n hay escasa evidencia econ&#243;mica sobre su implantaci&#243;n en pacientes con GPAA con o sin cataratas<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">40&#44;44</span></a>&#46; No obstante&#44; un estudio previo realizado con XEN&#174;45 demostr&#243; que su introducci&#243;n generaba potenciales ahorros al SNS espa&#241;ol en comparaci&#243;n con otras intervenciones &#40;trabeculectom&#237;a&#44; EPNP&#44; EXPRESS&#174; e iStent&#174;&#41;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">28</span></a>&#46; Los resultados de este estudio indican que la incorporaci&#243;n de XEN&#174;63 en el manejo quir&#250;rgico del GPAA podr&#237;a asociarse a potenciales ahorros derivados de una menor necesidad de visitas de seguimiento&#44; menores tasas de complicaciones y procedimientos adicionales posquir&#250;rgicos que las cirug&#237;as filtrantes convencionales u otros MIGS&#47;MPGS&#46; Adem&#225;s&#44; el menor coste de la intervenci&#243;n en comparaci&#243;n con el resto de alternativas permite que XEN&#174;63 se presente como una alternativa viable para ser incorporada en los servicios sanitarios&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El estudio no estuvo exento de limitaciones&#46; Por una parte&#44; el n&#250;mero de expertos del panel &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; podr&#237;a limitar la representatividad a nivel nacional en los consensos acordados&#59; no obstante&#44; se emple&#243; un reciente estudio realizado en 80 glaucomat&#243;logos del &#225;mbito p&#250;blico espa&#241;ol con el objetivo de cubrir el manejo de la patolog&#237;a en todo el entorno espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a>&#46; Por otra parte&#44; dada la falta de literatura publicada sobre la pr&#225;ctica cl&#237;nica y el uso de recursos asociados al manejo quir&#250;rgico del GPAA en Espa&#241;a&#44; se formularon varias hip&#243;tesis a trav&#233;s de la opini&#243;n de expertos y un an&#225;lisis de mercado reciente representativo del entorno sanitario nacional<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a>&#46; Este estudio pretende servir al menos de ejemplo ilustrativo del potencial uso de recursos y de las actuales t&#233;cnicas quir&#250;rgicas empleadas en el tratamiento del GPAA en Espa&#241;a&#44; siendo conscientes de la posible variabilidad en los costes totales de las intervenciones seg&#250;n el tipo de hospital&#44; derivado del coste parcial referido a la adquisici&#243;n de los dispositivos en estos centros&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se requerir&#225;n m&#225;s estudios que permitan evaluar el impacto m&#225;s a largo plazo de la introducci&#243;n de XEN&#174;63 en el manejo quir&#250;rgico del GPAA en pacientes con o sin cataratas cuyos tratamientos previos hayan fallado&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0145" class="elsevierStylePara elsevierViewall">La inclusi&#243;n de XEN&#174;63 como tratamiento quir&#250;rgico del GPAA refractario podr&#237;a suponer un ahorro econ&#243;mico para el SNS al ser una alternativa que&#44; a pesar de las limitaciones descritas&#44; permite satisfacer la necesidad no cubierta de intervenciones con un perfil de seguridad asociado a menores complicaciones quir&#250;rgicas&#44; a un coste asequible&#44; reduciendo el tiempo quir&#250;rgico y la necesidad de procedimientos adicionales&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Declaraci&#243;n de AbbVie</span><p id="par0150" class="elsevierStylePara elsevierViewall">El dise&#241;o&#44; la realizaci&#243;n del proyecto y el apoyo financiero para el estudio ha sido proporcionado por AbbVie&#46; AbbVie intervino en la interpretaci&#243;n de los datos&#44; la revisi&#243;n y la aprobaci&#243;n de la publicaci&#243;n&#46; No se efectuaron honorarios ni pagos por la autor&#237;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Declaraci&#243;n sobre la adquisici&#243;n de Allergan</span><p id="par0155" class="elsevierStylePara elsevierViewall">El 8 de mayo de 2020 AbbVie complet&#243; su adquisici&#243;n de Allergan&#44; que ahora forma parte de AbbVie&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</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 y Elena Mill&#225; declaran no tener ning&#250;n conflicto de intereses relacionado con esta publicaci&#243;n&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Cristina de Miguel&#44; Rosa Palomino y Estefan&#237;a Ur&#237;a son empleados a tiempo completo de Pharmalex&#46; Pharmalex ha recibido soporte financiero de AbbVie para asesor&#237;a t&#233;cnica en el desarrollo de proyectos con XEN&#46; Los empleados de Pharmalex a t&#237;tulo personal o Pharmalex a nivel empresarial no han recibido ninguna compensaci&#243;n econ&#243;mica de AbbVie por su participaci&#243;n como autores del presente art&#237;culo&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Julia Salvador es antigua empleada de AbbVie y Almudena Asorey es empleada de AbbVie&#44; y ambas pueden ser propietarias de acciones de AbbVie&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" 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="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" 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<span class="elsevierStyleHsp" style=""></span>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 poscirug&#237;a&#44; se emplearon datos de la literatura y se validaron con un panel de cuatro expertos&#46; Los costes unitarios &#40;&#8364;<span class="elsevierStyleHsp" style=""></span>de<span class="elsevierStyleHsp" style=""></span>2021&#41; se obtuvieron de la base de datos ESALUD&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La inclusi&#243;n de XEN&#174;63 podr&#237;a generar un ahorro de 2&#46;569&#46;737<span class="elsevierStyleHsp" style=""></span>&#8364; tras un a&#241;o desde su introducci&#243;n&#44; derivado del ahorro en el coste del implante y del procedimiento &#40;&#8722;423&#46;120&#59; &#8722;0&#44;7&#37;&#41;&#44; de las visitas de seguimiento &#40;&#8722;777&#46;407<span class="elsevierStyleHsp" style=""></span>&#8364;&#59; &#8722;4&#44;5&#37;&#41;&#44; de los procedimientos adicionales &#40;&#8722;1&#46;048&#46;145<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; &#8722;20&#44;6&#37;&#41; y de las complicaciones poscirug&#237;a &#40;&#8722;321&#46;065<span class="elsevierStyleHsp" style=""></span>&#8364;&#44; &#8722;14&#44;2&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" 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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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" 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="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" 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<span class="elsevierStyleHsp" style=""></span>year&#46; The comparators considered &#40;trabeculectomy&#44; deep non-perforating sclerectomy&#44; Ahmed valve&#44; iStent inject&#174;&#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="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" 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;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="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The incorporation of XEN&#174;63 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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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Poblaci&#243;n diana candidata a recibir XEN&#174;63&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">GPAA&#58; glaucoma primario de &#225;ngulo abierto&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fuentes&#58; 1&#46; INE<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a>&#59; 2&#46; Ant&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a>&#46; 3&#46; European Glaucoma Society<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#59; 4&#46; Stein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a>&#59; 5&#46; Lorenz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a>&#59; 6&#46; Allergan&#46; Datos internos<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a>&#46;</p>"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Resultados del impacto presupuestario&#46; a&#41;<span class="elsevierStyleHsp" style=""></span>Coste e impacto presupuestario total&#46; b&#41;<span class="elsevierStyleHsp" style=""></span>Coste e impacto presupuestario desglosado por categor&#237;as&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Tratamientos&nbsp;\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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Escenario actual&#40;sin XEN&#174;63&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Escenario potencial&#40;con XEN&#174;63&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \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
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\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">Trabeculectom&#237;a&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">14&#44;80&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;806&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">12&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;086&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">Trabeculectom&#237;a<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">22&#44;20&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;709&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">20&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;144&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">EPNP&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">12&#44;80&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;292&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">11&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;829&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">EPNP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">19&#44;20&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;938&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">18&#44;2&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;681&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">Preserflo&#174; microshunt&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">1&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">257&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">4&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;029&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">Preserflo&#174; microshunt<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">1&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">257&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">1&#44;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
                  \t\t\t\t\ttop\n
                  \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; inject&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">1&#44;20&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">309&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">1&#44;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
                  \t\t\t\t\ttop\n
                  \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; inject<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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&#44;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
                  \t\t\t\t\ttop\n
                  \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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;029&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">XEN&#174;45&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">5&#44;90&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;517&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">0&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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">XEN&#174;45<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">11&#44;90&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;060&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">0&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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">Ahmed&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">5&#44;80&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;492&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">4&#44;2&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;080&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">Ahmed<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>catarata&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">1&#44;20&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">309&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">0&#44;6&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&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">XEN&#174;63&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">0&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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\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;63<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">0&#44;00&#37;&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">0&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">14&#44;0&#37;&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">3&#46;601&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de mercado en los escenarios sin y con XEN&#174;63</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
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            0 => array:1 [
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                0 => """
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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  " align="" valign="\n
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                  \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\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revisi&#243;n ampolla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Retirar suturas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Goniopunci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hipema &#40;en quir&#243;fano&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desprendimiento coroidal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Contacto endotelial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Atalamia&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">Trabeculectom&#237;a&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">8&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">15&#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">15&#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">1&#44;5&#37;&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">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">2&#37;&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">1&#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">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">10&#37;&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">Trabeculectom&#237;a<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">8&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">15&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#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">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">10&#37;&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">EPNP&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">8&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">9&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&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">EPNP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cataratas&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">8&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">11&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">0&#37;&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">Preserflo&#174; microshunt&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">7&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">13&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">Ahmed<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>catarata&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Uso de recursos y complicaciones asociado a la intervenci&#243;n durante el primer a&#241;o tras la cirug&#237;a</p>"
        ]
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      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t">17&#46;264&#46;632 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;050&#46;571 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">257&#46;882 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">224&#46;582 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">137&#46;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
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                  \t\t\t\t">434&#46;896 &#8364;&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
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                  \t\t\t\t">399&#46;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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coste de complicaciones poscirug&#237;a</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">2&#46;253&#46;836 &#8364;&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">1&#46;932&#46;771 &#8364;&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"><span class="elsevierStyleHsp" style=""></span>Coste de hipema &#40;en quir&#243;fano&#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&#46;530 &#8364;&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">331&#46;643 &#8364;&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">261&#46;463 &#8364;&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">213&#46;272 &#8364;&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"><span class="elsevierStyleHsp" style=""></span>Coste de contacto endotelial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&#46;408 &#8364;&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">173&#46;179 &#8364;&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"><span class="elsevierStyleHsp" style=""></span>Coste de atalamia&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;432&#46;435 &#8364;&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">1&#46;214&#46;677 &#8364;&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  " align="left" valign="\n
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                  \t\t\t\t">85&#46;881&#46;517 &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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ISSN: 03656691
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