Cost-Effectiveness of Retinal Detachment Repair

Abstract

Objective To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair. Design A Markov model of cost-effectiveness and utility. Participants There were no participants. Methods Published clinical trials (index studies) of pneumatic retinopexy (PR), scleral buckling (SB), pars plana vitrectomy (PPV) and laser prophylaxis were used to quantitate surgical management and visual benefits. Markov analysis, with data from the Center of Medicare and Medicaid Services (CMS), was used to calculate adjusted costs of primary repair by each modality in a hospital-based and ambulatory surgery center (ASC) setting. Main Outcome Measures Lines of visual acuity (VA) saved, cost of therapy, adjusted cost of therapy, cost per line saved, cost per line-year saved, cost per quality-adjusted life years (QALY) saved. Results In the facility, hospital surgery setting, weighted cost for PR ranged from $3,726 to $5,901 depending on estimated success rate of primary repair. Weighted cost for SB was $6,770, for PPV was $7,940 and for laser prophylaxis was $1,955. The dollars per line saved ranged from $217 to $1,346 depending on the procedure. Dollars per line-year saved ranged from $11 to $67. Dollars per QALY saved ranged from $362 to $2,243. In the non-facility, ASC surgery setting, weighted cost for PR ranged from $1,961 to $3,565 depending on the success rate of primary repair. The weighted costs for SB, PPV and laser prophylaxis were $4,873, $5,793 and $1,255, respectively. Dollars per line saved ranged from $139 to $982. The dollars per line-year saved ranged from $7–$49 and the dollars per QALY saved ranged from $232 to $1,637. Conclusions Treatment and prevention of RD is extremely cost-effective when compared to other treatment of other retinal diseases regardless of treatment modality. RD treatment costs did not vary widely, suggesting providers can tailor patient treatments solely on the basis of optimizing anticipated results since there were not overriding differences in financial impact.

Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia

“…We chose to also evaluate costs in terms of Medicare allowable reimbursements as they remain the gold standard for setting the fee schedule for many insurance companies and more closely affect the experience of financial cost from the perspective of the insurance company, the patient, and society. Studies in prostate cancer, 31 lung cancer, 32 macular degeneration, 33 retinal detachment repair, 34 and macular holes 35 have used Medicare allowable reimbursements to establish costs for comparative analysis and cost effectiveness. The out of pocket cost for treatment of OSSN to a Medicare patient would differ based on two factors—whether they had secondary insurance, and if they did, whether the cost of topical medications would be covered.…”

Update on pneumatic retinopexy

“…A comparison of dollars/quality of life year saved showed a similar trend with pneumatic retinopexy having the most utility with figures of US $554 (pneumatic retinopexy), US $1377 (scleral buckling), and US $1637 (PPV)[22 …”

Cost Evaluation of Surgical and Pharmaceutical Options in Treatment for Vitreomacular Adhesions and Macular Holes

“…34-39 The cost per QALY saved of IVO in this model ranged from $8,159 to $10,244. In comparison, the cost per QALY for the treatment of diabetic macular edema (DME) with anti-vascular endothelial growth factor (VEGF) agents was $4,160-$23,119 depending on the agent or protocol used in one study, 36 and another Markov analysis of treatment for DME showed a cost per QALY ranging from $11,138-89,903.…”

“…37 In contrast, the cost per QALY of retinal detachment repairs is $554-$2,243. 39 From this analysis, IVO is on the lower end of the range of therapy as compared to pharmacologic-based treatment of these other chronic retinal diseases, with the added benefit of being a lifelong durable effect with a one-time therapy. Still, treatment of these conditions have in common the greater share of costs going to pharmaceutical manufacturers and a lower share going to professional and facility fees.…”

“…Despite this, the relative relationships of the costs do not vary by region and the actual costs do not vary by greater than 10%. 39 If anything, the pharmaceutical cost is stable in all regions and it is the CMS reimbursement portions that would be lower in other regions. An observation arm was also not included in this evaluation, and reports suggest that a sizeable, but unpredictable, proportion of a select group of patients with VMA may resolve with observation alone.…”