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2014 ; 121
(9
): 1720-6
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Cost evaluation of surgical and pharmaceutical options in treatment for
vitreomacular adhesions and macular holes
#MMPMID24835758
Chang JS
; Smiddy WE
Ophthalmology
2014[Sep]; 121
(9
): 1720-6
PMID24835758
show ga
OBJECTIVE: To evaluate cost-effectiveness and cost utilities for treatment
options for vitreomacular adhesions (VMAs) and full-thickness macular holes
(MHs). DESIGN: A Markov model of cost-effectiveness and utility. PARTICIPANTS:
There were no participants. METHODS: Outcomes of published clinical trials (index
studies) of surgical treatment of VMAs and MHs and a prospective, multicenter
clinical trial of pharmaceutical vitreolysis with intravitreal ocriplasmin with
saline control were used to generate a model for costs of treatment and visual
benefits. All techniques were assumed to result in a 2.5-line visual benefit if
anatomy was resolved. Markov analysis, with cost data from the Centers for
Medicare and Medicaid Services, was used to calculate imputed costs for each
primary treatment modality in a facility setting, with surgery performed in a
hospital serving as the highest end of the range and nonfacility setting with
surgery performed in an ambulatory surgery center serving as the lowest end of
the range. MAIN OUTCOME MEASURES: Imputed costs of therapy, cost per line saved,
cost per line-year saved, cost per quality-adjusted life years (QALYs). RESULTS:
When pars plana vitrectomy (PPV) was selected as the primary procedure, the
overall imputed cost ranged from $5802 to $7931. The cost per line was $2368 to
$3237, the cost per line-year saved was $163 to $233 and the cost per QALY was
$5444 to $7442. If intravitreal injection of ocriplasmin was the primary
procedure, the overall imputed cost was $8767 to $10 977. The cost per line
ranged from $3549 to $4456, the cost per line-year saved was $245 to $307, and
the cost per QALY was between $8159 and $10 244. If intravitreal saline injection
was used as a primary procedure, the overall imputed cost was $5828 to $8098. The
cost per line was $2374 to $3299, the cost per line-year saved was $164 to $227,
and the cost per QALY was $5458 to $7583. CONCLUSIONS: As a primary procedure,
PPV was the most cost-effective therapy in this model. The other treatments had
similar costs per QALY saved and compare favorably with costs of therapy for
other retinal diseases.
|Clinical Trials as Topic
[MESH]
|Cost-Benefit Analysis
[MESH]
|Fibrinolysin/*economics
[MESH]
|Fibrinolytic Agents/*economics
[MESH]
|Health Care Costs/*statistics & numerical data
[MESH]