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F. B. Chu, D. E. Vollman, R. S. Apte, B. H. Cohen, C. J. Siegfried, S. M. Kymes; An Economic Evaluation of Prophylactic NSAID Use With Cataract Surgery to Prevent Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4562.
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To provide a framework for the decision to use prophylactic NSAIDs with cataract surgery in order to prevent cystoid macular edema (CME). We performed an economic analysis to determine if the cost of prophylactic NSAIDs is offset by the risk and costs of managing pseudophakic CME.
We constructed a decision analytic model using data from the peer-reviewed literature to compare the costs of management of pseudophakic CME when using prophylactic NSAIDs in combination with steroids versus prophylactic steroids alone. Analysis was conducted from the payor’s perspective (e.g. Medicare). Literature searches of PubMed and the Cochrane Library provided probabilities and costs for various therapies in post-surgical management. A simple decision model was constructed describing a single episode of CME from cataract surgery to resolution of CME or vitrectomy. Among the costs accounted for were medications for prophylaxis and treatment of CME, office visits, subtenon and intravitreal steroids, vitrectomy, and the management of complications of therapies. We relied on an estimate from Wolf et al (2007 JCRS) of 2.1% for the incidence of CME in patients not receiving prophylactic NSAIDs, to provide a conservative estimate of risk. We made the additional conservative assumptions that prophylactic NSAIDs have 100% efficacy in preventing CME, and that no cases of CME spontaneously resolve. The data were analyzed in TreeAge Pro 2009. We report the expected cost of care of CME for the two strategies.
The expected cost of management of CME following cataract surgery for patients using prophylactic NSAIDs was $92.88, which accounts for the cost of medication. For those not receiving NSAIDs, the expected cost of management of CME was $16.67, which represents the cost of treatment of CME and follow-up. We estimate that the use of NSAIDs prevents approximately 1 in 7000 patients from resulting in a BCVA of 20/200 or worse.
Our model demonstrates that using prophylactic NSAIDs with cataract surgery is not likely to be considered cost-effective. Using prophylactic NSAIDs incurs an incremental cost of $76.21 per surgery, and results in a cost of $645,000 per case of BCVA of 20/200 or worse prevented. Given that roughly 2.8 million cataract surgeries are performed each year, we estimate that prophylactic NSAID medication adds over $200 million to the healthcare system without evidence of comparable benefit.
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