How cost utility justifies retinal detachment repair

Listen to William E. Smiddy, MD, present the The Joseph Smiddy Memorial Lecture during the Current Concepts in Ophthalmology meeting at the Wilmer Eye Institute/Johns Hopkins University. Peter J. McDonnell, MD, chairman of the Wilmer Eye Institute, introduced Dr. Smiddy, whose talk was entitled, "Cost Utility of Retinal Detachment Repair."

Take-home

Repair of retinal detachment is cost effective, especially when compared with injection-based treatments.

By Liz Meszaros; Reviewed by William E. Smiddy, MD

Miami-Repair of retinal detachment is valuable and cost effective, particularly when compared with other ophthalmologic (especially injection-based) and non-ophthalmologic treatments, according to William E. Smiddy, MD.

“Health-care costs have been increasingly scrutinized-especially by the non-providers and the non-receivers of health care,” said Dr. Smiddy, professor of ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.

“All too often, the newer treatments are quick to be incorporated into the mainstream without any really good standardization for what this really is costing,” Dr. Smiddy said.

Though pharmacologic-based treatments have revolutionized the ability to help patients with a wider array of disease processes, they are expensive compared with surgical costs, he noted.

“I have a real fear that the expense of these newer treatments may not be as valuable and may run the risk of crowding out some of the things we have that are very effective,” Dr. Smiddy said.

“We can be confident, and probably should be better at articulating the cost effectiveness of surgically based treatments, especially in the repair of retinal detachments,” he said. “We need to make this point by speaking the language of the health-care-policy makers.”

Cost utility

Cost utility is perhaps the most crucial parameter, Dr. Smiddy continued.

The most useful measurement tool is the time trade-off (TTO) method, for which patients must answer how much of their remaining life expectancy would they be willing to trade for the correction of a medical illness. TTO measurements allows for comparisons across a range of medical conditions.

For example, a person with a low CD4 count with AIDS might be willing to give up about 21% of his or her expected life to be cured, he noted. Someone with severe angina might be willing to give up 17% or almost half of his or her life so as not to be afflicted with angina.¹

“We can apply this to ophthalmology, and find that for every given line of visual loss, we can calculate a certain utility,” Dr. Smiddy said. “This comes out to a 0.03 or 3% of [a patient’s] life for each additional line of vision [that one] may be able to obtain.”

Measuring costs

Treatment options for retinal detachment include pneumatic retinopexy, scleral buckling, vitrectomy, and a combined pars plana vitrectomy/scleral buckle procedure. These are all relatively highly successful treatments for this potentially blinding condition, Dr. Smiddy noted.

He, along with Jonathan Chang, MD, developed a Markov model of primary retinal detachment repair that included surgical fees, ambulatory surgery center/hospital costs, the cost of cataract extraction, anesthesia costs, and outpatient exam fees for 1 year of care.

“Retinal detachment surgery compares very favorably with other surgical treatments, and is almost as cost effective as PRP is for preventing visual loss due to proliferative diabetic retinopathy,” Dr. Smiddy said. “Similarly, these numbers are very much less than the injection-based numbers for certain agents.

“When we have similar costs for the same result, we can feel completely justified in trying to tailor the treatment to the patient and the situation,” he concluded. “Either way, although treatment of choice is not a slam dunk, all options are very cost effective.”

Reference

1.     Brown MM, Brown GC, Sharma S, Landy J. Health care economic analyses and value-based medicine. Survey of Ophthalmol. 2003;48:204-223.

William E. Smiddy, MD

P: 305/243-4000

Dr. Smiddy delivered the Joseph Smiddy Memorial Lecture at the annual Current Concepts in Ophthalmology conference at the Wilmer Eye Institute in association with Ophthalmology Times. Dr. Smiddy is an attendee of the Alimera Sciences steering committee.

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