Abstract
Purpose :
Intravitreal ocriplasmin (IVO) has altered the therapeutic landscape for vitreomacular interface pathology. Recent studies have demonstrated improving success rates and this highlights the question of the cost effectiveness of IVO compared to the current standard of care - pars plana vitrectomy (PPV). The purpose of this study is to provide a new patient pool to evaluate cost efficacy of IVO for vitreomacular adhesion (VMA) and macular hole (MH).
Methods :
A retrospective single center, multiple physician, IRB approved study was done of 247 patients with VMA and MH over 15 months. Clinical charts and imaging were cross referenced with billing records and total treatment cost was determined. Patients were divided into three groups: Group 1 – VMA and MH treated by PPV, Group 2 – VMA and MH treated by IVO, Group 3 – VMA treated by IVO.
Results :
Initial interventional success rates were 98% (Group 1), 55.6% (Group 2), 67.7% (Group 3). Secondary success rates were 66.6% (Group 1), 81.8% (Group 2), 90% (Group 3). Cost of PPV at our institution was $6,538 and IVO cost was $3480. Quality-adjusted life years (QALY) calculation (based on average life expectancy of 14.3 years from mean patient age of 71.2 years) demonstrated an average of 2.5 lines of vision saved from successful treatment.Using a cohort-based computer model the treatment decision tree demonstrated Group 1 patients had a cost per line of $2,654.39,cost per line-year saved of $185.62, and cost per QALY of $6,187. Group 2 treatment was more cost effective with a cost per line of $2,456.25, cost per line year saved of $171.77, and cost per QALY of $5,726. The difference in cost effectiveness showed IVO was more cost effective than PPV as an initial intervention, with a difference in cost per line of $198.14, cost per line-year saved of $13.85, and cost per QALY of $461. Group 3 was cost effective with increased success rates for initial and secondary procedures.
Conclusions :
IVO is a cost-effective intervention for VMA and MH with appropriate patient selection. The success rate of IVO in our patient population was greater than previously published rates, which may reflect more optimal patient selection. The success rates likely impacted the weighted probability model of cost efficacy and further research targeting optimizing success rates of IVO will be beneficial to optimize the cost efficacy of this therapeutic intervention.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.