Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmology. 2014 Apr;121(4):946-51. doi: 10.1016/j.ophtha.2013.11.003. Epub 2014 Jan 9.
To evaluate costs and treatment benefits of rhegmatogenous retinal detachment (RD) repair.
A Markov model of cost-effectiveness and utility.
There were no participants.
Published clinical trials (index studies) of pneumatic retinopexy (PR), scleral buckling (SB), pars plana vitrectomy (PPV), and laser prophylaxis were used to quantitate surgical management and visual benefits. Markov analysis, with data from the Center of Medicare and Medicaid Services, was used to calculate the adjusted costs of primary repair by each modality in a hospital-based and ambulatory surgery center (ASC) setting.
Lines of visual acuity (VA) saved, cost of therapy, adjusted cost of therapy, cost per line saved, cost per line-year saved, and cost per quality-adjusted life years (QALY) saved.
In the facility, hospital surgery setting, weighted cost for PR ranged from $3726 to $5901 depending on estimated success rate of primary repair. Weighted cost was $6770 for SB, $7940 for PPV, and $1955 for laser prophylaxis. The dollars per line saved ranged from $217 to $1346 depending on the procedure. Dollars per line-year saved ranged from $11 to $67. Dollars per QALY saved ranged from $362 to $2243. In the nonfacility, ASC surgery setting, weighted cost for PR ranged from $1961 to $3565 depending on the success rate of primary repair. The weighted costs for SB, PPV, and laser prophylaxis were $4873, $5793, and $1255, respectively. Dollars per line saved ranged from $139 to $982. The dollars per line-year saved ranged from $7 to $49, and the dollars per QALY saved ranged from $232 to $1637.
Treatment and prevention of RD are extremely cost-effective when compared with other treatment of other retinal diseases regardless of treatment modality. Retinal detachment treatment costs did not vary widely, suggesting that providers can tailor patient treatments solely on the basis of optimizing anticipated results because there were no overriding differences in financial impact.
评估孔源性视网膜脱离（RRD）修复的成本和治疗效益。
成本效益和效用的马尔可夫模型。
无参与者。
使用充气视网膜固定术（PR）、巩膜扣带术（SB）、经睫状体平坦部玻璃体切除术（PPV）和激光预防的已发表临床试验（索引研究）来量化手术管理和视力获益。使用来自医疗保险和医疗补助服务中心的数据进行马尔可夫分析，以计算在医院和门诊手术中心（ASC）环境下每种方式进行初次修复的调整后的治疗成本。
视力线数保存、治疗成本、调整后的治疗成本、每条线保存的成本、每条线保存的年成本和每个质量调整生命年（QALY）保存的成本。
在设施、医院手术环境中，PR 的加权成本范围为 3726 美元至 5901 美元，具体取决于初次修复的估计成功率。SB 的加权成本为 6770 美元，PPV 为 7940 美元，激光预防为 1955 美元。每条线节省的费用从 217 美元到 1346 美元不等，具体取决于手术方式。每条线保存的年成本从 11 美元到 67 美元不等。每条 QALY 保存的成本从 362 美元到 2243 美元不等。在非设施、ASC 手术环境中，PR 的加权成本范围为 1961 美元至 3565 美元，具体取决于初次修复的成功率。SB、PPV 和激光预防的加权成本分别为 4873 美元、5793 美元和 1255 美元。每条线节省的费用从 139 美元到 982 美元不等。每条线保存的年成本从 7 美元到 49 美元不等，每条 QALY 保存的成本从 232 美元到 1637 美元不等。
与治疗其他视网膜疾病的其他治疗方法相比，RRD 的治疗和预防具有极高的成本效益。视网膜脱离的治疗费用差异不大，这表明提供者可以仅根据预期结果优化患者的治疗，因为在财务影响方面没有压倒性的差异。
