A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery

PURPOSE: To perform a reference case, cost-utility analysis of epiretinal membrane (ERM) surgery using current literature on outcomes and complications. DESIGN: Computer-based, value,based medicine analysis. METHODS: Decision analyses were performed under two scenarios: ERM surgery in better-seeing eye and ERM surgery in worse,seeing eye. The models applied long-term published data primarily from the Blue Mountains Eye Study and the Beaver Dam Eye Study. Visual acuity and major complications were derived from 25, gauge pars plana vitrectomy studies. Patient,based, time trade,off utility values, Markov modeling, sensitivity analysis, and net present value adjustments were used in the design and calculation of results. Main outcome measures included the number of discounted quality, adjusted,life-years (QALYs) gained and dollars spent per QALY gained. RESULTS: ERM surgery in the better-seeing eye compared with observation resulted in a mean gain of 0.755 discounted QALYs (3% annual rate) per patient treated. This model resulted in $4,680 per QALY for this procedure. When sensitivity analysis was performed, utility values varied from $6,245 to $3,746/QALY gained, medical costs varied from $3,510 to $5,850/ QALY gained, and ERM recurrence rate increased to $5,524/QALY. ERM surgery in the worse-seeing eye compared with observation resulted in a mean gain of 0.27 discounted QALYs per patient treated. The $/QALY was $16,146 with a range of $20,183 to $12,110 based on sensitivity analyses. Utility values ranged from $21,520 to $12,916/QALY and ERM recurrence rate increased to $16,846/QALY based on sensitivity analysis. CONCLUSIONS: ERM surgery is a very cost,effective procedure when compared with other interventions across medical subspecialties.