title: The cost-effectiveness of early vitrectomy for the treatment of vitreous hemorrhage in diabetic retinopathy.
abstract: Diabetic vitrectomy has been found to be efficacious for the treatment of vitreous hemorrhage secondary to diabetic retinopathy. The purpose of this study is to determine the cost-effectiveness of early vitrectomy for the management of vitreous hemorrhage secondary to diabetic retinopathy. The analysis was performed from the perspective of a third-party insurer. A cost-utility Markov model was used to determine the cost per quality-adjusted life year (QALY) gained from early versus deferral of vitrectomy. The model used 2-, 3-, and 4-year results from the Diabetic Retinopathy Vitrectomy Study, patient-based utilities, life expectancy data, and incremental medical costs. Early vitrectomy was the dominant strategy and was associated with a gain of 0.41 QALYs over the 57-year expected life span for a hypothetical patient. The cost per additional QALY gained from early vitrectomy treatment was $1910 (US$ discounted at 3%). When sensitivity analyses were performed by varying efficacy probabilities and utilities across their 95% confidence intervals, early treatment was always the dominant strategy. Additionally, even at the extreme sensitivity values, the cost per QALY of early vitrectomy treatment remained under $10,000. Overall, early vitrectomy for the treatment of vitreous hemorrhage secondary to diabetic retinopathy is highly cost-effective.
authors.affiliation: The Cost-Effective Ocular Health Policy Unit, Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada. sanjay_sharma60@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: H
authors.initials: H
authors.lastname: Hollands
authors.forename: G C
authors.initials: GC
authors.lastname: Brown
authors.forename: M M
authors.initials: MM
authors.lastname: Brown
authors.forename: G K
authors.initials: GK
authors.lastname: Shah
authors.forename: S M
authors.initials: SM
authors.lastname: Sharma
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000150:complications*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D011788:Quality of Life; D014792:Visual Acuity; D014821:Vitrectomy / Q000191:economics*; D014823:Vitreous Hemorrhage / Q000191:economics / Q000209:etiology / Q000601:surgery*