An economic evaluation comparing pars plan vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) found that all 3 procedures are viable options for managing rhegmatogenous retinal detachment (RRD). Though pars plana vitrectomy may be the most cost-effective over a lifetime, there are many factors to consider when determining the best option for each patient.
Study design
This model-based cost-utility analysis sought to assess the cost-effectiveness of primary noncomplex RRD repair via PPV, SB, or PnR. The 3 surgical methods were compared using a simulated cohort of 100,000 adult patients in theoretical US surgicenters. Data from existing literature was used to create the model, with primary and secondary success and complication rates derived using 2 Cochrane reviews and costs estimated from Medicare data. Quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICER) for each intervention were projected.
Outcomes
Based on input parameters, the primary anatomical success rate was highest for PPV (95%), followed by SB (92%) and PnR (63%). Pars plana vitrectomy had the highest rate of cataract formation (55% vs 38% for PnR and 14% for SB); scleral buckle had the highest rate of postoperative retinal pathology (11.4% vs 10.6% for PnR and 9.7% for PPV). When including additional associated surgeries over a lifetime, the estimated total cost for scleral buckle averaged $4518; lifetime estimated costs for PPV and PnR were marginally less at $4446 and $3978, respectively. Mean QALYs were slightly higher for PPV (11.9) than for SB (11.8) or PnR (11.6).
Limitations
The major limitation of this study is that it was based on a simulated model rather than true patient data. Also, since the simulation was based on tertiary care centers in the United States, it may not be feasible to extrapolate the results to private practice settings or locations outside of the US. The model also assumed that primary PnR failure would be followed by a repeat PnR, when it would more likely be followed by PPV.
Clinical significance
Based on the results of this model, the authors concluded that PPV is the most cost-effective option over a lifetime, largely driven by its high anatomical success rate and a comparison of postoperative complications among the 3 procedures. However, physicians choose among these 3 surgical techniques based on what they feel most comfortable performing as well as what they determine to be the best procedure for the individual patient, weighing lens status, patient cooperation, and secondary comorbidities. Physicians do not typically weigh cost in this decision-making process. That said, knowing the cost-effectiveness of PPV may help inform policy-making regarding resource allocation.
Financial Disclosures: Dr. Lisa Schocket discloses no financial relationships.