Yan William, Paul Rodger, Allen Penelope, Dawkins Rosie
The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
J Vitreoretin Dis. 2025 Sep 3:24741264251364008. doi: 10.1177/24741264251364008.
To perform a cost-utility analysis comparing primary pars-plana vitrectomy (PPV) within 24 hours with primary nonsurgical vitreous tap (or tap and inject [T&I]) for the management of endophthalmitis. Retrospective cost-utility analysis using decision tree modeling. The Victorian Endophthalmitis Registry was used to model outcome probabilities and costs from a third-party payer perspective. Australian Medicare data were used to calculate costs in a hospital-based setting (Australian dollars [A$]). Cost utility was based on preserved visual acuity and cost per quality-adjusted life year (QALY). The authors identified 206 eyes treated between January 1, 2011, and January 1, 2021; 36 eyes received PPV, and 170 eyes received T&I. Seventeen eyes in the T&I group required delayed PPV. Mean incident ages were 76.29 years (53% female) in the PPV group and 74.28 years (55% female) in the T&I group. Imputed costs were A$1,523 and A$310 for PPV and T&I, with additional per-night admission costs of A$1,177. The mean presenting vs discharge logMAR of endophthalmitis was 2.24 vs 1.25 for the PPV group and 1.88 vs 1.03 for the T&I group. The mean durations of admission were 4.33 nights (PPV) and 4.04 nights (T&I). Total calculated costs per admission were A$6,929.41 and A$5,065.08 for PPV and T&I, respectively. Estimated lifetime QALYs gained were 2.23 (PPV) and 2.45 (T&I). The final costs derived per QALY were A$3,107 (PPV) and A$2,067 (T&I). PPV and T&I are both cost-effective per gained QALY, though the latter provided superior cost utility. A prospective randomized trial is indicated as the 2 groups differed at baseline, with eyes receiving vitrectomy having worse presenting visual acuity and prognosis.
为了进行成本效用分析，比较在24小时内进行的原发性玻璃体切割术（PPV）与原发性非手术性玻璃体穿刺（或穿刺并注射 [T&I]）治疗眼内炎的效果。采用决策树模型进行回顾性成本效用分析。利用维多利亚眼内炎登记处的数据，从第三方支付者的角度对结果概率和成本进行建模。使用澳大利亚医疗保险数据计算基于医院环境的成本（澳元 [A$]）。成本效用基于保留的视力和每质量调整生命年（QALY）的成本。作者确定了2011年1月1日至2021年1月1日期间治疗的206只眼；36只眼接受了PPV，170只眼接受了T&I。T&I组中有17只眼需要延迟进行PPV。PPV组的平均发病年龄为76.29岁（53%为女性），T&I组为74.28岁（55%为女性）。PPV和T&I的估算成本分别为1523澳元和310澳元，每晚的额外住院成本为1177澳元。PPV组眼内炎患者就诊时与出院时的平均对数最小分辨角（logMAR）视力分别为2.24和1.25，T&I组为1.88和1.03。平均住院时间分别为4.33晚（PPV）和4.04晚（T&I）。PPV和T&I每次住院的总计算成本分别为6929.41澳元和5065.08澳元。估计获得的终身QALY分别为2.23（PPV）和2.45（T&I）。每QALY产生的最终成本分别为3107澳元（PPV）和2067澳元（T&I）。PPV和T&I每获得一个QALY都具有成本效益，尽管后者具有更高的成本效用。鉴于两组在基线时存在差异，接受玻璃体切割术的眼睛就诊时视力和预后较差，因此需要进行一项前瞻性随机试验。
