title: Twenty-five-gauge vitrectomy versus 23-gauge vitrectomy in the management of macular diseases: a comparative analysis through a Health Technology Assessment model.
abstract: Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.
authors.affiliation: Vitreoretinal Service, Torino Eye Hospital, via Juvarra 19, Turin, Italy, 78andreagrosso@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Grosso
authors.forename: Lorena
authors.initials: L
authors.lastname: Charrier
authors.forename: Emanuela
authors.initials: E
authors.lastname: Lovato
authors.forename: Claudio
authors.initials: C
authors.lastname: Panico
authors.forename: Cesare
authors.initials: C
authors.lastname: Mariotti
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Dapavo
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiuminatto
authors.forename: Roberta
authors.initials: R
authors.lastname: Siliquini
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Gianino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012163:Retinal Detachment / Q000601:surgery*; D012167:Retinal Perforations / Q000601:surgery*; D013536:Suture Techniques; D013673:Technology Assessment, Biomedical / Q000379:methods*; D014792:Visual Acuity; D014821:Vitrectomy / Q000191:economics / Q000379:methods*