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  • Cost-Utility Comparison of RRD Interventions

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Retina
    Published online Aug. 30, 2021

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    Belin et al. performed a cost-utility comparison of three procedures com­monly used to repair rhegmatogenous retinal detachments (RRDs): scleral buckle (SB), pars plana vitrectomy (PPV), and the combination procedure (SB-PPV). They found that SB was modestly better than PPV or SB-PPV in terms of cost-effectiveness. In addition, they found that the expenses associated with any of these procedures were far below the maximum willingness-to-pay standard, indicating that all three have a favorable cost-utility profile.

    This study was a secondary analysis of patient data from the Primary Retinal Detachment Outcomes Study and fee data from CMS. Mathematical model­ing was used to estimate specific costs, lifetime utility (quality-adjusted life years [QALYs] afforded), and lifetime cost per QALY for phakic patients with moderately complex RRD who received SB, PPV, or SB-PPV. Costs were estimated for hospital ORs and ambu­latory surgery centers. It was assumed that costs for the initial and subsequent follow-up office exams were the same for all three procedures; therefore, these costs were not included in the analyses.

    Results were as follows:

    • The estimated costs and QALYs gained were $5,975 and 5.4 (respectively) with SB, $8,125 and 4.7 with PPV, and $7,551 and 4.7 with SB-PPV. This corresponds to costs per QALY of $1,106 for SB, $1,729 for PPV, and $1,607 for the combined procedure.
    • The estimated cost of ambulatory surgery centers was $3,774 for SB, $5,082 for PPV, and $4,713 for SB-PPV.
    • The overall costs associated with any of these procedures were found to be well below the willingness-to-pay ceiling of $100,000 to $150,000 per QALY.
    • At $1,106 per QALY, SB was marginally superior to PPV and SB-PPV, but the authors acknowledged that the SB group was younger, which may have contributed to the lower cost per QALY.

    These findings suggest that SB, PPV, and SB-PPV are highly and similarly cost-effective for managing moder­ately complex RRD. In particular, the researchers said, these findings “should encourage retinal surgeons to utilize whichever method they believe will be most successful given the patient’s RRD characteristics, and give payers the con­fidence that repair of RRD is a highly cost-effective therapy.”

    The original article can be found here.