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Cost-effectiveness of early treatment for retinopathy of prematurity
Karen L Kamholz1, Cynthia H Cole, James E Gray
1Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA. karen.kamholz@bmc.org
Insights
Early treatment for retinopathy of prematurity (ROP) improves visual outcomes and is economically desirable. Despite higher initial costs, this strategy offers long-term cost savings by preventing severe visual impairment.
Area of Science:
- Ophthalmology
- Health Economics
- Neonatal Care
Background:
- Early Treatment for Retinopathy of Prematurity (ETROP) trial showed improved visual outcomes with early peripheral retinal ablation for high-risk prethreshold ROP.
- Early treatment increased laser therapy frequency, anesthesia, systemic complications, and repeat treatments compared to conventional management at threshold disease.
Purpose of the Study:
- To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity (ROP) versus conventional management.
Main Methods:
- Developed a stochastic decision analytic model to assess the incremental cost per eye with severe visual impairment prevented.
- Utilized resource-use and efficacy data from the ETROP trial.
- Employed a third-party payer perspective, with primary analysis through 9 months' corrected gestational age and a secondary lifetime horizon analysis.
Main Results:
- The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented.
- There was a 90% probability that early treatment cost-effectiveness would be under $40,000 per eye with severe visual impairment prevented.
- Limiting early treatment to "type 1 retinopathy of prematurity" reduced cost-effectiveness to $6,200 per eye; lifetime analyses indicated early treatment was cost-saving.
Conclusions:
- Early treatment for retinopathy of prematurity is both efficacious and economically advantageous.
- The early treatment strategy yields long-term cost savings due to the high lifetime costs associated with severe visual impairment.
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.
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