Original articleA Value-Based Medicine Cost-Utility Analysis of Idiopathic Epiretinal Membrane Surgery
Section snippets
Model Design
Economic models were designed using software produced by TreeAge, Inc (Williamstown, Massachusetts, USA). Decision analyses were performed under two scenarios: ERM surgery in better-seeing eye and ERM surgery in worse-seeing eye. A decision analysis tree was utilized for the ERM surgery in the better-seeing eye scenario because the ERM surgery was assumed to be definitive. Markov modeling, which evaluates recurrent risk, was employed for the ERM surgery in the worse-seeing eye scenario. This
Better-Eye Scenario
The mean utility of 0.755 was obtained by decision analysis for ERM surgery in the better-seeing eye (Figure 1). This utility incorporates a weighted average of all the complications of ERM and cataract surgery over the remainder of the patient's life. The mean utility value for no intervention was 0.669. ERM surgery in the better-seeing eye compared with observation resulted in a mean gain of 0.93 discounted QALYs over the 19-year life expectancy of the reference case.
This model resulted in a
Discussion
Epiretinal membranes are a common finding reported to be present in 7% to 12% of older adults.2, 3, 5 In those over the age of 75 years, the incidence increases to 20% of eyes.19 The natural history of this condition has been outlined in previous studies.3, 5 Nearly one-third have been reported to progress over a five-year period.5 ERMs not only cause metamorphopsia and decreased VA, but also reduced quality-of-life.20
Since the original description by Machemer,21 ERM surgery has become an
Omesh P. Gupta, MD, MBA, is currently a Heed vitreoretinal fellow at Wills Eye, Philadelphia, Pennsylvania. He graduated AOA from a 5-year program with an MD with Distinction in Research and an MBA with a concentration in Health Sciences Management. He was then a resident and Co-chief Resident at Wills Eye. Dr Gupta has contributed in over 35 articles, book chapters, and presentations. He serves on the Editorial Board of Retina Today and Evidence-Based Ophthalmology.
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Cost-Utility of Rhegmatogenous Retinal Detachment Repair With Pars Plana Vitrectomy, Scleral Buckle, and Pneumatic Retinopexy: A Microsimulation Model
2023, American Journal of OphthalmologyIdiopathic Epiretinal Membrane and Vitreomacular Traction
2016, OphthalmologyEffect of Vitrectomy for Epiretinal Membrane on Visual Function and Vision-Related Quality of Life
2009, American Journal of OphthalmologyCitation Excerpt :This improvement of VR-QOL in patients with ERM was higher than these in MH and AMD.17,18 Gupta and associates demonstrated that ERM surgery was a very cost-effective procedure using quality-adjusted-life-years (QALYs) methods.28 The cost-effectiveness ratio for ERM surgery was higher than MH surgery.
Economic Implications of Current Age-Related Macular Degeneration Treatments
2009, OphthalmologyCitation Excerpt :In a previous study using similar methodology and assumptions, the cost/line-year ranged from $21 for laser treatment for proliferative diabetic retinopathy and $33/line-year for scleral buckling treatment for retinal detachment to approximately $100 for most usual vitrectomy interventions.19 This disparity also is evidenced by cost-utility analyses that have found costs of $2000 per quality-adjusted life-year vitrectomy for diabetic vitrectomy and $4500 for epiretinal membrane removal,33,34 compared with approximately $50 000 (second eye) to $125 000 (first eye) for 2 years of protocol-style ranibizumab treatment for AMD.35 By any metric, anti-VEGF treatment of AMD is much more costly than previous AMD or retinal treatments.
Health care stakeholder perceptions of vision loss
2019, Survey of OphthalmologyCitation Excerpt :This factor has not been integrated into earlier cost-utility analyses. We believe that the considerable patient value delivered by ophthalmic interventions using patient vision utilities5,7–10,15,41,42,46,57,60,61,65 bodes well for these interventions in the future. Nonetheless, the assignment of less utility gain, as recommended by some4 for elderly and disabled patients, could derail the patient-derived value gains conferred by ophthalmic interventions.
Development of a generative deep learning model to improve epiretinal membrane detection in fundus photography
2024, BMC Medical Informatics and Decision Making
Omesh P. Gupta, MD, MBA, is currently a Heed vitreoretinal fellow at Wills Eye, Philadelphia, Pennsylvania. He graduated AOA from a 5-year program with an MD with Distinction in Research and an MBA with a concentration in Health Sciences Management. He was then a resident and Co-chief Resident at Wills Eye. Dr Gupta has contributed in over 35 articles, book chapters, and presentations. He serves on the Editorial Board of Retina Today and Evidence-Based Ophthalmology.