title: Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial.
abstract: OBJECTIVE
  To determine whether internal limiting membrane (ILM) peeling is cost-effective compared with no peeling for patients with an idiopathic stage 2 or 3 full-thickness macular hole.
  
  
  METHODS
  A cost-effectiveness analysis was performed alongside a randomised controlled trial. 141 participants were randomly allocated to receive macular-hole surgery, with either ILM peeling or no peeling. Health-service resource use, costs and quality of life were calculated for each participant. The incremental cost per quality-adjusted life year (QALY) gained was calculated at 6 months.
  
  
  RESULTS
  At 6 months, the total costs were on average higher (£424, 95% CI -182 to 1045) in the No Peel arm, primarily owing to the higher reoperation rate in the No Peel arm. The mean additional QALYs from ILM peel at 6 months were 0.002 (95% CI 0.01 to 0.013), adjusting for baseline EQ-5D and other minimisation factors. A mean incremental cost per QALY was not computed, as Peeling was on average less costly and slightly more effective. A stochastic analysis suggested that there was more than a 90% probability that Peeling would be cost-effective at a willingness-to-pay threshold of £20,000 per QALY.
  
  
  CONCLUSIONS
  Although there is no evidence of a statistically significant difference in either costs or QALYs between macular hole surgery with or without ILM peeling, the balance of probabilities is that ILM Peeling is likely to be a cost-effective option for the treatment of macular holes. Further long-term follow-up data are needed to confirm these findings.
authors: Institute of Health & Society, Newcastle University, Baddiley-Clarke Building, Newcastle Upon Tyne NE2 4AX, UK. laura.ternent@ncl.ac.uk
authors: Laura
authors: L
authors: Ternent
authors: Luke
authors: L
authors: Vale
authors: Charles
authors: C
authors: Boachie
authors: Jennifer M
authors: JM
authors: Burr
authors: Noemi
authors: N
authors: Lois
mesh_terms: D001485:Basement Membrane / Q000601:surgery*; D003362:Cost-Benefit Analysis; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012167:Retinal Perforations / Q000191:economics* / Q000601:surgery*; D011795:Surveys and Questionnaires