Incremental cost-effectiveness of laser therapy for visual loss secondary to branch retinal vein occlusion

PURPOSE To ascertain the incremental cost-effectiveness of therapeutic interventions for improving visual loss associated with branch retinal vein occlusion. METHODS A cost-utility analysis incorporating data from the Branch Vein Occlusion Study Group was performed using patient-based preferences obtained from time tradeoff utility analysis, decision analysis with Markov modeling, and economic modeling with future value analysis. The cost-effectiveness results are expressed in $/QALY (dollars expended per quality-adjusted life-year) gained. This unique model takes into account the visual acuity in the better seeing eye and the recurrent risk for visual loss in the contralateral eye. RESULTS Laser therapy for macular edema secondary to branch retinal vein occlusion was associated with an incremental $/QALY gained of $6118 (in year 2000 U.S. dollars). Two-way sensitivity analysis, varying the discount rate and the proportion of patients developing a vascular occlusion in the contralateral eye, revealed a range of $/QALY gained from $3370 to $19,299. CONCLUSIONS Laser therapy appears to be a cost-effective intervention for improving visual loss associated with macular edema secondary to branch retinal vein occlusion. Variants of the methodology employed to calculate the incremental cost-effectiveness of this intervention can be widely applied across all specialties in medicine.