title: Cost-effectiveness of early treatment for retinopathy of prematurity.
abstract: BACKGROUND
  The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management.
  
  
  METHODS
  We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses.
  
  
  RESULTS
  The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving.
  
  
  CONCLUSIONS
  Early treatment of retinopathy of prematurity is both efficacious and economically desirable. Because of the high lifetime costs of severe visual impairment, the early treatment strategy provides long-term cost savings.
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA. karen.kamholz@bmc.org
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kamholz
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Cole
authors.forename: James E
authors.initials: JE
authors.lastname: Gray
authors.forename: John A F
authors.initials: JA
authors.lastname: Zupancic
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods; D003663:Decision Trees; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D018803:Models, Economic; D015337:Multicenter Studies as Topic / Q000191:economics*; D016032:Randomized Controlled Trials as Topic / Q000191:economics*; D012178:Retinopathy of Prematurity / Q000191:economics* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome