Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Ophthalmology. 2018 Jan;125(1):43-50. doi: 10.1016/j.ophtha.2017.06.019. Epub 2017 Jul 18.
To evaluate the costs and cost-utility of examination for posterior vitreous detachment (PVD) and treatment of associated pathology, and of managing various other peripheral retinal disorders to prevent retinal detachment (RD).
A decision analysis model of cost-utility.
There were no participants.
Published retrospective data on the natural course of PVD, retinal tears, and lattice degeneration were used to quantitate the visual benefits of examination and treatment. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility/ambulatory surgical center (ASC)-based setting. Published standards of utility for a given level of visual acuity were used to derive costs and quality-adjusted life years (QALYs).
Cost of evaluation and treatment, utility of defined health states, QALY, and cost per QALY.
The modeled cost of evaluation of a patient with PVD and treatment of associated pathology in the facility/hospital (nonfacility/ASC)-based setting was $65 to $190 ($25-$71) depending on whether a single or 2-examination protocol was used. The cost per QALY saved was $255 to $638/QALY ($100-$239/QALY). Treatment of a symptomatic horseshoe tear resulted in a net cost savings of $1749 ($1314) and improved utility, whereas treatment of an asymptomatic horseshoe tear resulted in $2981/QALY ($1436/QALY). Treatment of asymptomatic lattice degeneration in an eye in which the fellow eye had a history of RD resulted in $4414/QALY ($2187/QALY).
Evaluation and management of incident acute PVD (and symptomatic horseshoe tears) offer a low cost and a favorable cost-utility (low $/QALY) as a result of the minimization of the cost and morbidity associated with the development of RD, thus justifying current practice standards.
评估检查和治疗后玻璃体脱离（PVD）及相关病变、治疗各种其他周边视网膜疾病以预防视网膜脱离（RD）的成本和成本效用。
成本效用的决策分析模型。
无。
使用 PVD、视网膜裂孔和格子状变性的自然病程的已发表回顾性数据来量化检查和治疗的视觉益处。使用医疗保险和医疗补助服务中心的数据，在医院/设施基础和非设施/门诊手术中心（ASC）基础环境中计算相关模型成本。使用特定视力水平的效用发表标准来得出成本和质量调整生命年（QALY）。
评估和治疗的成本、健康状态的效用、QALY 和每 QALY 的成本。
在设施/医院（非设施/ASC）基础环境中，对 PVD 患者进行评估和治疗相关病变的模型成本为 65 至 190 美元（25 至 71 美元），具体取决于使用单一或 2 次检查方案。每节省一个 QALY 的成本为 255 至 638 美元/QALY（100 至 239 美元/QALY）。治疗有症状的马蹄形撕裂会导致净成本节省 1749 美元（1314 美元）和效用提高，而治疗无症状的马蹄形撕裂会导致 2981 美元/QALY（1436 美元/QALY）。在曾经发生过 RD 的对侧眼有无症状格子状变性的眼中治疗该病会导致每 QALY 花费 4414 美元（2187 美元/QALY）。
评估和管理偶发性急性 PVD（以及有症状的马蹄形撕裂）的成本和成本效用较低（每 QALY 成本低），因为可以最大限度地降低与 RD 发展相关的成本和发病率，从而证明了当前的实践标准是合理的。
