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Benjamin Rostami, Jeannie Nguyen-Cuu, Gary Brown, Melissa Brown, Alfredo A Sadun, J Sebag; Cost-Effectiveness of Limited Vitrectomy for Vision Degrading Vitreopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5217. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Clinically significant vitreous floaters, or Vision Degrading Vitreopathy, negatively impact quality of life (AJO 152:60–5, 2011) by reducing contrast sensitivity function (AJO 172:7-12, 2016; Surv Ophth 61:211-27, 2016). Limited vitrectomy normalizes structural (IOVS 56:1611–7, 2015) and functional (Retina 34:1062-8, 2014) abnormalities. This study ascertains the patient preference-based comparative effectiveness and cost-effectiveness of vitrectomy for Vision Degrading Vitreopathy.
42 myopic (>-2D; mean = -6.0 ± 3.35 D) patients (52±14 years; mean life expectancy = 30 years), with subjectively bothersome floaters completed the NEI Visual Function Questionnaire (VFQ-25) on the same visit as baseline visual acuity (VA; logMAR) and contrast sensitivity function (CSF; Freiburg Acuity Contrast Test). Following limited 25G vitrectomy leaving retrolental vitreous intact and without inducing surgical PVD, the same tests were repeated. An average cost-utility analysis was performed using the national Medicare Fee Schedule, patient time tradeoff utilities correlated with the NEI-VFQ-25, and a third-party insurer cost perspective. Costs and patient value gain (in QALY, or quality-adjusted life-year) outcomes were discounted with net present value analysis at 3% per annum over a 30-year horizon.
Mean F/U was 13.6 months. There were no infections, IOP irregularities, retinal detachments, or macular edema. Acute vitreous hemorrhage in 2 cases cleared spontaneously within 3 weeks and cataract surgery was subsequently undertaken in 4/32 (12.5%) phakic eyes. LogMar VA improved by 24.6% (0.16 to 0.10) (p<0.001), CSF improved by 45.5% (p<0.001), and the VFQ score by 20.2% (75.3 to 89.0) (p<0.001). The 30-year incremental patient value gain conferred by limited vitrectomy was 2.18 QALY using NEI-VFQ 25 data and utility correlations, representing a 13.5% quality-of-life gain. Total cost in 2017 was $3,376. The cost-utility ratio using NEI-VFQ-25 utilities was $1,552/QALY, which is very cost-effective referent to often used upper limit of cost-effectiveness of $100,000/QALY.
Limited vitrectomy safely improves visual acuity, contrast sensitivity function, and visual quality of life. There is a 13.5% quality-of-life improvement with excellent cost-effectiveness. Future studies using CSF data may show more advantageous cost-effectiveness, as CSF improvement was two-fold greater than the other outcome measures.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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