A cost-utility analysis of interventions for severe proliferative vitreoretinopathy

Purpose: The purpose of this study was to report a reference case, patient preference,based, incremental, cost,utility analysis for treatments of retinal detachment associated with severe proliferative vitreoretinopathy (PVR). Design: Computer based economic model utilizing data from the Medicare health insurance system in the United States. Methods: A cost-utility analysis compared vitreoretinal surgery using expanding gases and silicone oil therapy to the natural course of retinal detachment associated with severe PVR. The model applies long-term published visual data from the Silicone Study Group, time tradeoff utility analysis, decision analysis with Markov modeling, and discounting of costs and health benefits as per the Panel on Cost-Effectiveness in Health and Medicine. The major outcome measure was in year 2000 United States dollars per quality-adjusted life-year ($/QALY) gained. Results: Vitreoretinal surgery for retinal detachment complicated by severe PVR, as compared with no treatment, resulted in a mean gain of 0.128-0.200 discounted (3% annual rate) quality,adjusted life,years per treated patient. Silicone oil ($/QALY gained of $40,252) was slightly more cost-effective than perfluoropropane (C3F8) gas ($/QALY gained of $46,926) in eyes with PVR without previous vitrectomy, whereas C3F8 gas ($/QALY gained of $46,162) was more cost,effective than silicone oil ($/QALY gained of $62,383) with previous vitrectomy and PVR. Sensitivity analysis resulted in a $/QALY gained of $13,347 when 10% of opposite eyes had a severe visual loss to $202,128 when a discount rate of 10% was utilized and opposite eyes initially had good vision. Conclusions: The incremental expense of interventions for retinal detachment associated with PVR is cost,effective when compared with other widely accepted interventional therapies across diverse medical specialties. (Am J Ophthalmol 2002;133:365-372. (C) 2002 by Elsevier Science Inc. All rights reserved.).