Trabeculectomy More Cost-Effective Than Tube Shunts

Analysis finds trabeculectomy typically better financial option than tube shunt surgery as first treatment for glaucoma.

Mar. 2, 2026 at 4:55pm

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A secondary analysis of data from the 2022 PTVT Study found that trabeculectomy is more cost-effective than tube shunt surgery as a first-line procedure to treat glaucoma. The cost-utility analysis showed trabeculectomy had lower third-party and societal costs, as well as better quality-adjusted life year (QALY) outcomes, compared to tube shunts. However, tube shunts may be more cost-effective for patients with very high intraocular pressure (IOP) readings above 21 mm Hg.

Why it matters

This analysis provides important economic data to consider alongside clinical factors when selecting the initial surgical approach for glaucoma patients. As glaucoma treatments can be costly, understanding the relative cost-effectiveness of different procedures can help guide personalized care and ensure the most appropriate and efficient use of healthcare resources.

The details

The cost analysis looked at third-party costs for clinic visits, medications, surgery, and anesthesia, as well as societal costs for direct expenses, travel, missed work, and caregiver burden. The utility analysis measured quality-adjusted life years (QALYs), factoring in visual function, symptoms, and treatment burden. An incremental cost-effectiveness ratio (ICER) below $50,000 per QALY was considered cost-effective. The analysis used a disease simulation model with 100,000 eyes for each procedure over five 1-year cycles.

  • The findings come from a secondary analysis of the 2022 PTVT Study.
  • The results were presented at the American Glaucoma Society (AGS) 2026 Annual Meeting.

The players

Adam Rothman

A glaucoma specialist at Bascom Palmer Eye Institute at the University of Miami in Plantation, Florida, who presented the study results.

Inas Aboobakar

A retina specialist at Mass Eye and Ear and Harvard Medical School in Boston, who commented on the study's strengths and limitations.

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What they’re saying

“These economic findings should be considered alongside other individual factors when selecting the initial surgical approach.”

— Adam Rothman, Glaucoma specialist

“The results of this study suggest that patient-specific clinical factors, such as baseline IOP, can help provide insights into what would be the most cost-effective approach for a given patient, enabling personalized glaucoma care.”

— Inas Aboobakar, Retina specialist

The takeaway

This analysis highlights the importance of considering both clinical and economic factors when selecting the optimal initial surgical treatment for glaucoma patients. By understanding the relative cost-effectiveness of different procedures, clinicians can work with patients to choose the approach that provides the best outcomes and value.