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


METHODS
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.
Gupta
Omesh P
OP
Retina Service, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA. ogupta1@hotmail.com
Brown
Gary C
GC
Brown
Melissa M
MM
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019773:Epiretinal Membrane / Q000191:economics* / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014481:United States; D014792:Visual Acuity; D014821:Vitrectomy / Q000191:economics*