Cost-Utility of Evaluation for Posterior Vitreous Detachment and Prophylaxis of Retinal Detachment.

PubMed ID: 28732590

Author(s): Yannuzzi NA, Chang JS, Brown GC, Smiddy WE. Cost-utility of evaluation for posterior vitreous detachment and prophylaxis of retinal detachment. Ophthalmology. 2018 Jan;125(1):43-50. doi: 10.1016/j.ophtha.2017.06.019. Epub 2017 Jul 18. PMID 28732590

Journal: Ophthalmology, Volume 125, Issue 1, Jan 2018

PURPOSE To evaluate the costs and cost-utility of examination for posterior vitreous detachment (PVD) and treatment of associated pathology, and of managing various other peripheral retinal disorders to prevent retinal detachment (RD).

DESIGN A decision analysis model of cost-utility.

PARTICIPANTS There were no participants.

METHODS Published retrospective data on the natural course of PVD, retinal tears, and lattice degeneration were used to quantitate the visual benefits of examination and treatment. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility/ambulatory surgical center (ASC)-based setting. Published standards of utility for a given level of visual acuity were used to derive costs and quality-adjusted life years (QALYs).

MAIN OUTCOME MEASURES Cost of evaluation and treatment, utility of defined health states, QALY, and cost per QALY.

RESULTS The modeled cost of evaluation of a patient with PVD and treatment of associated pathology in the facility/hospital (nonfacility/ASC)-based setting was $65 to $190 ($25-$71) depending on whether a single or 2-examination protocol was used. The cost per QALY saved was $255 to $638/QALY ($100-$239/QALY). Treatment of a symptomatic horseshoe tear resulted in a net cost savings of $1749 ($1314) and improved utility, whereas treatment of an asymptomatic horseshoe tear resulted in $2981/QALY ($1436/QALY). Treatment of asymptomatic lattice degeneration in an eye in which the fellow eye had a history of RD resulted in $4414/QALY ($2187/QALY).

CONCLUSIONS Evaluation and management of incident acute PVD (and symptomatic horseshoe tears) offer a low cost and a favorable cost-utility (low $/QALY) as a result of the minimization of the cost and morbidity associated with the development of RD, thus justifying current practice standards.