Cost-effectiveness Analysis of Endonasal Dacryocystorhinostomy using Markov Modeling

Abstract

Purpose : To determine the cost-effectiveness of endonasal dacryocystorhinostomy (DCR) compared to no surgical intervention.

Methods : We constructed a Markov model in which patients with nasolacrimal duct obstruction (NLDO) received endonasal dacryocystorhinostomy (DCR) or no surgical intervention. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost in dollars per quality-adjusted life year (QALY) gained. Treatments with an ICER below a willingness-to-pay (WTP) threshold of $50,000/QALY were considered cost-effective. One-way sensitivity analyses and probabilistic sensitivity analyses were utilized to evaluate for model sensitivity to cost, utilities and other model inputs.

Results : Endonasal DCR was associated with a 2.43 increase in QALY at an increased cost of $5,237 compared to no surgical intervention, resulting in an ICER of $2,162/QALY. The cost-effectiveness model was most sensitive to the health utility deduction from epiphora due to NLDO. Probabilistic sensitivity analysis found DCR to be the cost-effective option over no surgical intervention 94.0% of the time at a WTP threshold of $50,000/QALY.

Conclusions : Endonasal DCR is a cost-effective treatment for patients with epiphora due to NLDO. To further improve this analysis, larger studies still need to be conducted to further evaluate the success rates and complication rates of endonasal DCR for NLDO, and to determine the true utility value of epiphora.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.