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Gabriel M Gordon, Robert L Avery; Cost Evaluation of Pneumatic Vitreolysis in Treatment for Vitreomacular Adhesion. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1592.
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The purpose of this study was to determine which therapeutic option for treating vitreomacular traction (VMT) provides the most efficient cost per quality life-years (QALYS). A similar assessment was reported in 2014, but only compared saline treatments with ocriplasmin or vitrectomy (PPV). Since then a growing body of work has shown that treating VMT with pneumatic viteolysis (PV) results in a higher success rate and a cheaper procedure. Our hypothesis is that PV will prove to be a significantly better option for treating VMT as compared to other options with regards to the cost per QALYS.
Calculations were based off of the paper published by Chang and Smiddy and used identical assumptions. For PV, we assumed an 85% success rate based on recent work published by our clinic; the cost of the gas is less than $1 so is calculated as $0. Markov analysis, with cost data from the Center of Medicare and Medicaid Services (CMS), was used to calculate imputed costs for each primary treatment modality in a facility setting with surgery performed in a hospital serving as the highest end of the range and nonfacility setting with surgery performed in an ambulatory surgery center (ASC) serving as the lowest end of the range.
When PV was selected as the primary procedure, the overall imputed cost ranged from $2,913.62-$4,197.37 for facility and non-facility locations, respectively. These figures include the cost of vitrectomy for the patients who fail PV. The cost per line was $1,170.13-$1,685.69, the cost per line-year saved was $80.70- $116.25 and the cost per QALY was $2,689.95-$3,875.15.
In both a facility and non-facility setting, the PV cost per QALY is approximately half that of saline or PPV and one third that of ocriplamin, irrespective of success rate. This analysis confirms the superior cost effectiveness of this simple office procedure over vitrectomy or ocriplasmin injection for VMT.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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