Cost-effectiveness of early treatment for retinopathy of prematurity.

Abstract

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: Karen L Kamholz, Cynthia H Cole, James E Gray, John A F Zupancic
• Journal: Pediatrics (Pediatrics) Vol. 123 Issue 1 Pg. 262-9 (Jan 2009) ISSN: 1098-4275 [Electronic] United States
• PMID: 19117891 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Cost-Benefit Analysis (methods)
• Decision Trees
• Humans
• Infant, Newborn
• Infant, Premature
• Models, Economic
• Multicenter Studies as Topic (economics)
• Randomized Controlled Trials as Topic (economics)
• Retinopathy of Prematurity (economics, therapy)
• Time Factors
• Treatment Outcome