Original Title: Chirurgie micro-invasive du glaucome (CMIG) : Hydrus Microstent pour le traitement du glaucome léger à modéré

Authors' objectives: The Institut national d'excellence en santé et en services sociaux (INESSS) has been mandated by the Ministère de la Santé et des Services sociaux (MSSS) to assess the appropriateness of expanding public coverage of Hydrus Microstent technology, alone or in combination with phacoemulsification, for the treatment of adults with mild to moderate primary open-angle glaucoma (POAG).

Authors' results and conclusions: RESULTS (#1 POPULATION DIMENSION): Quebec medico-administrative data indicate that the majority of patients who underwent MIGS to treat their glaucoma also underwent phacoemulsification to treat their cataract. Clinicians consulted report that HydrusMC Microstent is a treatment option for several groups of people with MIGS. These include those who require cataract surgery; those with glaucoma poorly controlled by medication or laser; those with significant side effects to these treatment options; or those whose health condition does not allow them to apply eye drops correctly (e.g., those with arthritis, osteoarthritis or tremor). (#2 CLINICAL DIMENSION): Insertion of the Hydrus Microstent device appears to have a safety profile comparable to that of the various iterations of the iStentMC technology. However, data from some studies highlight the occurrence of bleeding in the anterior chamber of the eye, which is more frequent after implantation of Hydrus Microstent compared with iStent technologiesMC. Nevertheless, this bleeding resolved spontaneously one week after the procedure. Uncertainty also persists as to the need for re-intervention or repositioning of the HydrusMC Microstent compared with iStent. According to the literature, no differences in ocular discomfort or pain were reported by Hydrus Microstent compared with no stent, after analysis of responses to a patient questionnaire. (#3 ORGANIZATIONAL DIMENSION): Training provided by the manufacturer is required to obtain certification and thus authorization for the clinician to implant Hydrus Microstent. This training includes a theoretical portion, laboratory simulation and supervision of Hydrus Microstent implantation by the manufacturer until the clinician's competence has been demonstrated. Clinicians consulted report that HydrusMC Microstent technology requires a longer learning period than iStentMC inject. Nevertheless, the ophthalmologists consulted report that the efficacy of the procedure in terms of reducing the number of drugs required to achieve the target intraocular pressure with Hydrus Microstent appears slightly superior to that with iStent inject when surgeons are accustomed to this technology. (#4 SOCIO-CULTURAL DIMENSION): Several health technology assessment agencies have recognized MIGS as effective options for the treatment of glaucoma. Two countries, France and Australia, have recommended public coverage of Hydrus Microstent technology for people with POAG. (#5 ECONOMIC DIMENSION): The efficiency analysis by the INESSS shows that the addition of the Hydrus Microstent during cataract surgery would be an efficient and dominant intervention compared to phacoemulsification alone, as it generates fewer costs and more health benefits. However, these efficiency results remain uncertain and sensitive to certain assumptions. Public coverage of HydrusMC Microstent would generate additional costs of $6.8 million for the treatment of 1,783 patients over 3 years. This increase would result primarily from growth in the MIGS market, rather than from the substitution of Hydrus Microstent for the iStent device.

Authors' recommendations: The Institut national d'excellence en santé et en services sociaux (INESSS) is of the opinion that a decision in favour of public coverage of Hydrus Microstent technology for the treatment of adults with mild to moderate POAG would be a fair and reasonable decision if its use were guided by the following criteria:  Use of Hydrus Microstent technology in conjunction with phacoemulsification for: – a patient with poorly controlled glaucoma by two or more medications and laser treatment, or with significant adverse effects to these treatment options; – a patient with a documented health condition preventing optimal administration of eye drops; – a patient who is not a candidate for filtration surgery.

Authors' methods: A review of data from the literature and those provided by the manufacturer was conducted to assess the scientific evidence for Hydrus Microstent technology for the treatment of mild-to-moderate POAG. Contextual and experiential data from clinicians was also collected through an advisory committee of ophthalmologists and an ad hoc consultation with a clinician specializing in glaucoma treatment.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/chirurgies-microinvasives-du-glaucome-cmig-hydrusmc-microstent-pour-le-traitement-du-glaucome-leger-a-modere.html

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/chirurgies-microinvasives-du-glaucome-cmig-hydrusmc-microstent-pour-le-traitement-du-glaucome-leger-a-modere.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)