Original article
A Value-Based Medicine Cost-Utility Analysis of Idiopathic Epiretinal Membrane Surgery

https://doi.org/10.1016/j.ajo.2007.12.037Get rights and content

Purpose

To perform a reference case, cost-utility analysis of epiretinal membrane (ERM) surgery using current literature on outcomes and complications.

Design

Computer-based, value-based medicine analysis.

Methods

Decision analyses were performed under two scenarios: ERM surgery in better-seeing eye and ERM surgery in worse-seeing eye. The models applied long-term published data primarily from the Blue Mountains Eye Study and the Beaver Dam Eye Study. Visual acuity and major complications were derived from 25-gauge pars plana vitrectomy studies. Patient-based, time trade-off utility values, Markov modeling, sensitivity analysis, and net present value adjustments were used in the design and calculation of results. Main outcome measures included the number of discounted quality-adjusted-life-years (QALYs) gained and dollars spent per QALY gained.

Results

ERM surgery in the better-seeing eye compared with observation resulted in a mean gain of 0.755 discounted QALYs (3% annual rate) per patient treated. This model resulted in $4,680 per QALY for this procedure. When sensitivity analysis was performed, utility values varied from $6,245 to $3,746/QALY gained, medical costs varied from $3,510 to $5,850/QALY gained, and ERM recurrence rate increased to $5,524/QALY. ERM surgery in the worse-seeing eye compared with observation resulted in a mean gain of 0.27 discounted QALYs per patient treated. The $/QALY was $16,146 with a range of $20,183 to $12,110 based on sensitivity analyses. Utility values ranged from $21,520 to $12,916/QALY and ERM recurrence rate increased to $16,846/QALY based on sensitivity analysis.

Conclusions

ERM surgery is a very cost-effective procedure when compared with other interventions across medical subspecialties.

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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