Cost-effectiveness of Early Treatment for Retinopathy of Prematurity
| Autor: | Cynthia H. Cole, John A.F. Zupancic, James Gray, Karen Kamholz |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Pediatrics
medicine.medical_specialty Time Factors genetic structures Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Eye disease Visual impairment Vitrectomy Disease Humans Multicenter Studies as Topic Medicine Intubation Retinopathy of Prematurity health care economics and organizations Randomized Controlled Trials as Topic business.industry Decision Trees Infant Newborn Retinopathy of prematurity medicine.disease Models Economic Treatment Outcome Pediatrics Perinatology and Child Health medicine.symptom business Infant Premature Retinopathy |
| Zdroj: | Pediatrics. 123:262-269 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2007-2725 |
| Popis: | 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 $14200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40000 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 $6200 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. |
| Databáze: | OpenAIRE |
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