Gary C. Brown, MD, MBA (Wyndmoor, PA),* Melissa M. Brown, MD, MN, MBA (Flourtown, PA),* Sanjay Sharma, MD, MSc, MBA (Kingston, Canada)


To assess the value and cost-effectiveness of vitreoretinal interventions employing evidencebased data from clinical trials integrated with value-based medicine utility data and cost-utility (cost-effectiveness) analysis principles.


Value-based medicine analysis: Visual data are converted to utility form using patient utility analysis values. Value is assessed by quantifying the improvement an intervention confers in length of life and/or quality of life. All treatment benefits and adverse effects are incorporated. Outcomes are measured in the % value gain conferred by an intervention, as well as the number of quality-adjusted life-years (QALYs) gained. Costs are integrated with the
conferred value to arrive at a costutility (cost-effectiveness) ratio. Interventions with a costutility ratio of < $50,000/QALY are considered to be very cost-effective and those > $100,000/QALY are not considered to be cost-effective.


The conferred value and the cost-utility (in parentheses) associated with select vitreoretinal interventions are as follows. Laser therapy for proliferative retinopathy of prematurity: 17% ($807), vitrectomy for diabetic vitreous hemorrhage: 24.2% ($2,160), cataract surgery in the first eye: 20.8% ($2,219), cataract surgery in the second eye: 12.7% ($3,035), laser therapy for diabetic macular edema: 5.2% ($3,508), laser photocoagulation for extrafoveal, subfoveal choroidal neovascularization (CNV): 3.1% ($25,494), photodynamic therapy with verteporfin for classic subfoveal CNV: 8.1% ($31,527), surgery for PVR with silicone oil injection: 67% if only eye, 2.7% if first eye ($45,227), pegaptanib therapy for subfoveal CNV: 5.8%, ($66,865) and inpatient treatment for central retinal artery obstruction 0.7% ($6.9 million). Comparisons will also be made with non-ophthalmic interventions.


Value-based medicine quantifies the value conferred by all healthcare interventions. Overall, vitreoretinal interventions provide considerable value to patients and are very cost-effective. This information is especially important since policy makers and decision makers are increasingly looking at value-based medicine.
* Financial interest disclosed