BACKGROUND: The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments. OBJECTIVE: To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management. DESIGN/ METHODS: We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses. RESULTS: The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving. CONCLUSIONS: Early treatment of retinopathy of prematurity is both efficacious and economically desirable. Because of the high lifetime costs of severe visual impairment, the early treatment strategy provides long-term cost savings.
BACKGROUND: The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments. OBJECTIVE: To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management. DESIGN/ METHODS: We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses. RESULTS: The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving. CONCLUSIONS: Early treatment of retinopathy of prematurity is both efficacious and economically desirable. Because of the high lifetime costs of severe visual impairment, the early treatment strategy provides long-term cost savings.
Authors: Luz C Zepeda-Romero; Alonso Meza-Anguiano; Juan C Barrera-de León; Eusebio Angulo-Castellanos; Marco A Ramirez-Ortiz; José A Gutiérrez-Padilla; Clare E Gilbert Journal: Matern Child Health J Date: 2015-06
Authors: M E Mowitz; J A F Zupancic; D Millar; H Kirpalani; J S Gaulton; R S Roberts; W Mao; D Dukhovny Journal: J Perinatol Date: 2016-09-29 Impact factor: 2.521
Authors: R V Paul Chan; Samir N Patel; Michael C Ryan; Karyn E Jonas; Susan Ostmo; Alexander D Port; Grace I Sun; Andreas K Lauer; Michael F Chiang Journal: Trans Am Ophthalmol Soc Date: 2015
Authors: Elena Nicod; Timothy L Jackson; Federico Grimaccia; Aris Angelis; Marc Costen; Richard Haynes; Edward Hughes; Edward Pringle; Hadi Zambarakji; Panos Kanavos Journal: Eur J Health Econ Date: 2015-11-24
Authors: John A F Zupancic; Gui-Shuang Ying; Alejandra de Alba Campomanes; Lauren A Tomlinson; Gil Binenbaum Journal: J Perinatol Date: 2020-02-28 Impact factor: 2.521