title: Preference-based comparative effectiveness and   cost–effectiveness: a review and relevance of  value-based medicine for vitreoretinal interventions.
abstract: OBJECTIVE
  This analysis discusses the comparative effectiveness and cost-effectiveness of vitreoretinal interventions, measured in quality-adjusted life years (QALYs) and percentage patient value (PPV gain, or improvement in quality of life and/or length of life). The material is relevant since the Patient Protection and Affordable Care Act enacted by Congress with the support of the President has emphasized the critical importance of patient-based preferences.
  
  
  RESULTS
  The majority of preference-based, comparative effectiveness and cost-effectiveness vitreoretinal interventions assessed in the US healthcare literature are Value-Based Medicine analyses, thus comparable. These interventions confer a mean patient (human) value gain (improvement in quality of life) of 8.3% [SD 6.3%, 95% confidence interval (CI) + 2.6%]. The average cost-utility of these vitreoretinal interventions is US$23 026/QALY (SD US$24 508, 95% CI + US$8770). Most vitreoretinal interventions are very cost effective using a conventional US standard of US$50 000/QALY as the upper anchor for a very cost-effective intervention, and the World Health Organization of approximately US$142 200/QALY as the upper anchor for a cost-effective intervention.
  
  
  CONCLUSIONS
  Most vitreoretinal interventions confer considerable patient value and are very cost effective. Further standardization across healthcare is needed in the preference-based, comparative and cost-utility (cost-effectiveness) arena. The metrics of PPV (percentage patient value) gain and US$/PPV (dollars expended per percentage patient value gain) or financial value gain may be more user-friendly than the QALY.
authors.affiliation: Thomas Jefferson University,Wills Eye Institute, Philadelphia and Center for Value-Based Medicine, Flourtown, PA 19031, USA. mbrown@valuebasedmedicine.com
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Brown
authors.forename: Gary C
authors.initials: GC
authors.lastname: Brown
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Lieske
authors.forename: P Alexander
authors.initials: PA
authors.lastname: Lieske
mesh_terms: D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012164:Retinal Diseases / Q000191:economics* / Q000601:surgery; D057586:Vitreoretinal Surgery / Q000191:economics*