Updated Cost-Effectiveness of Intravitreal Ocriplasmin for Vitreomacular Adhesion and Macular Hole

Abstract

BACKGROUND AND OBJECTIVE: The purpose of this study is to provide an updated assessment of cost-efficacy of intravitreal ocriplasmin (IVO) for vitreomacular adhesion (VMA) and macular holes (MH). PATIENTS AND METHODS: This was a single-center, multiple-physician, institutional review board-approved, retrospective, 15-month cost-effectiveness analysis study (January 2015 to April 2016). Clinical charts and billing records of 247 patients with VMA and MH were reviewed. Patients were divided into group 1 (VMA and MH treated by pars plana vitrectomy [PPV]), group 2 (VMA and MH treated by IVO), and group 3 (VMA treated by IVO). Success rates of interventions in each group were compared, including cost-effectiveness, cost per line-year, and cost per quality-adjusted life-year (QALY). RESULTS: Success rates for initial intervention were 98% in group 1, 55.6% in group 2, and 67.7% in group 3. Cost of PPV at our institution was $6,538.00 and cost of IVO (2016) was $3,480.00. Using a cohort-based computer Markov model, the treatment decision tree demonstrated group 1 was less cost-effective, with cost per line of $2,654.39, cost per line-year saved of $185.62, and cost per QALY of $6,187.00. Group 2 was cost-effective with cost per line of $2,456.25, cost per line-year saved of $171.77, and cost per QALY of $5,726.00. The difference in cost-effectiveness showed IVO was more cost-effective than PPV, with a difference in cost per line of $198.14, cost per line-year saved of $13.85, and cost per QALY of $461.00. CONCLUSIONS: IVO is a more cost-effective intervention than vitrectomy for the treatment of VMA and MH in the setting of judicious use in appropriate patients. The success rate of IVO in our patient population was greater than currently published rates and most certainly impacted probability of cost-efficacy. Further research targeting optimizing IVO success rate is needed. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e240–e248.]

Assessment of Patients Whose Pars Plana Vitrectomy Operations Were Postponed in the Operating Room: Retrospective Study

“…Most vitreoretinal and other ophthalmic procedures result not only in patient satisfaction but also in financial recycyling. [11][12][13][14][15][16] The medical expenses spent on the patientphysician, hospital, and pre-operative examinations are effective in recycling. Most earn money from the health system adds to the gross national income and increases the country's welfare.…”

Cost–effectiveness analysis of ocriplasmin versus watchful waiting for treatment of symptomatic vitreomacular adhesion in the US

“…A 2014 cost evaluation in the USA setting showed a lower cost with pars plana vitrectomy compared with ocriplasmin [47], while a more recent cost evaluation found ocriplasmin to be more cost effective than vitrectomy [47,48]. However, interpretation of the results is limited by the failure of both studies to report an incremental analysis of cost-effectiveness for each alternative intervention versus the comparator (SOC) [47,48].…”

“…A 2014 cost evaluation in the USA setting showed a lower cost with pars plana vitrectomy compared with ocriplasmin [47], while a more recent cost evaluation found ocriplasmin to be more cost effective than vitrectomy [47,48]. However, interpretation of the results is limited by the failure of both studies to report an incremental analysis of cost-effectiveness for each alternative intervention versus the comparator (SOC) [47,48]. The current cost-effectiveness analysis overcomes some of the aforementioned limitations through the use of an incremental approach and reflects up-to-date clinical and cost data for the different treatment options.…”