Cost-Utility Analysis of Early Vitrectomy vs Intravitreal Biopsy and Injection for Endophthalmitis

Area of Science:

• Ophthalmology
• Health Economics
• Retrospective Cohort Study

Background:

• Endophthalmitis management requires timely intervention to preserve visual acuity.
• Primary pars-plana vitrectomy (PPV) and nonsurgical vitreous tap (or tap and inject [T&I]) are established treatment options.
• Comparative cost-utility analyses are crucial for optimizing healthcare resource allocation in managing endophthalmitis.

Purpose of the Study:

• To conduct a cost-utility analysis comparing primary PPV versus primary T&I for endophthalmitis.
• To evaluate the cost per quality-adjusted life year (QALY) for each management strategy.
• To inform clinical decision-making and healthcare policy regarding endophthalmitis treatment.

Main Methods:

• Retrospective cost-utility analysis utilizing decision tree modeling.
• Data sourced from the Victorian Endophthalmitis Registry and Australian Medicare.
• Cost analysis from a third-party payer perspective, focusing on preserved visual acuity and QALYs.

Main Results:

• A total of 206 eyes were analyzed; 36 received PPV and 170 received T&I.
• T&I resulted in lower costs per QALY (A$2,067) compared to PPV (A$3,107).
• While both methods were cost-effective, T&I demonstrated superior cost utility.

Conclusions:

• Both primary PPV and T&I are cost-effective interventions for endophthalmitis.
• Primary T&I offers superior cost utility compared to primary PPV.
• A prospective randomized trial is recommended due to baseline differences between the groups.