目的:评估原发性非复杂性孔源性视网膜脱离(RRD)修复的成本效益,比较3种不同的策略,平坦部玻璃体切除术(PPV),巩膜带扣(SB),从医疗保健支付者的角度来看,气动视网膜固定术(PnR)在一生中。
方法:基于模型的成本效用分析。
方法:在美国理论外科中心进行100,000名需要原发性非复杂RRD修复的成年患者(≥18岁)的模拟队列。质量调整寿命年(QALYs),终身成本(2022年美元),3种干预措施的增量成本效益比(ICER)是在整个生命周期内预测的,每个获得的QALY的成本效益门槛≤50,000美元。
结果:根据输入的参数,与SB(91.76%)和PnR(63.41%)相比,PPV的主要解剖学成功率最高(95.00%).与PPV相关的QALY,SB,PnR为(11.87,SD1.62),(11.84,标准差1.63),和(11.59,标准差1.72),分别。RRD修复和相关PPV术后手术的终生费用,SB,和PnR为$4445.72(SD655.75),$4518.04(662.92),和3978.45美元(728.50美元),分别。参数水平模拟表明,与SB和PnR相比,PPV最有可能是超过$3000/QALY阈值的最具成本效益的治疗方法。与PnR相比,PPV的增量成本效益比为1693.54美元。SB在所有情况下都占主导地位。阈值分析表明,PnR的成功率必须为100%,并且/或者在整个生命周期中成本必须为2000美元或更低,才能比PPV更具成本效益。
结论:这项研究发现,从医疗保健支付者的角度来看,PPV是RRD修复的最具成本效益的主要程序,其门槛为50,000美元/QALY。
OBJECTIVE: To assess the cost-effectiveness of primary noncomplex rhegmatogenous retinal detachment (RRD) repair, comparing 3 different strategies, pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) from the health care payer perspective over a lifetime.
METHODS: Model-based cost-utility analysis.
METHODS: A simulated cohort of 100,000 adult patients (≥18 years old) requiring primary noncomplex RRD repair in theoretical surgical centers in the United States. Quality-adjusted life years (QALYs), lifetime costs (2022 United States dollars), and the incremental cost-effectiveness ratio (ICER) of the 3 interventions were projected over a lifetime horizon, with a cost-effectiveness threshold of ≤$50,000 per gained QALY.
RESULTS: Based on inputted parameters, the primary anatomical success was highest for PPV (95.00%) compared to SB (91.76%) and PnR (63.41%). The QALYs associated with PPV, SB, and PnR were (11.87, SD 1.62), (11.84, SD 1.63), and (11.59, SD 1.72), respectively. The incurred lifetime costs of RRD repair and associated postoperative surgeries for PPV, SB, and PnR were $4445.72 (SD 655.75), $4518.04 (662.92), and $3978.45 (728.50), respectively. Parameter-level simulations suggested that PPV was most likely to be the most cost-effective therapy compared to SB and PnR beyond a threshold of $3000/QALY. The incremental cost-effectiveness ratio for PPV compared to PnR was $1693.54. SB was dominant in all scenarios. Threshold analyses indicated that the success rate of PnR would have to be 100% and/or the cost would have to be $2000 or less over lifetime for it to be more cost-effective than PPV.
CONCLUSIONS: This study found PPV to be the most cost-effective primary procedure for RRD repair at a threshold of $50,000/QALY gained over a lifetime horizon from the health care payer perspective.