Document Detail


Cost-effectiveness of 2 approaches to managing nasolacrimal duct obstruction in infants: the importance of the spontaneous resolution rate.
MedLine Citation:
PMID:  21555614     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the impact of the rate of spontaneous resolution of congenital nasolacrimal duct obstruction on the relative cost-effectiveness of deferred nasolacrimal duct probing in a surgical facility (DFPS) compared with an immediate office-based probing surgery (IOPS).
METHODS: Data from the literature, Medicare 2009 fee schedule, and consensus assumptions were combined to populate a model of outcomes of 2 treatment strategies: immediate office-based probing (IOPS) and deferred facility-based probing (DFPS) (deferred for 6 months). Sensitivity analyses were conducted, varying the 6-month spontaneous resolution rate from 50% to 90%. Additional factors varied during analyses included surgical cost and each procedure's probability of success. Outcomes measured were overall cost of treatment, chance of cure, and months of symptoms avoided by 18 months of life.
RESULTS: Under the base case, assuming a 75% spontaneous resolution rate during 6 months prior to deferred probing, IOPS is more expensive ($771 vs $641) and slightly less effective (93.0% vs 97.5%) than DFPS, although IOPS costs only $44 per month of symptoms avoided. At spontaneous resolution rates between 50% and 68%, IOPS costs less than DFPS (from $2 to $342 less), although it also is slightly less effective (from 2.0% to 3.8% less). At a 90% spontaneous resolution rate, IOPS costs $169 per month of symptoms avoided. As the rate of spontaneous resolution falls, the cost per additional success for DFPS increases to $16 709 at a 50% spontaneous resolution rate.
CONCLUSION: The relative cost-effectiveness of these strategies for treatment of nasolacrimal duct obstruction depends on the spontaneous resolution rate after diagnosis.
Authors:
Kevin D Frick; Luxme Hariharan; Michael X Repka; Danielle Chandler; B Michele Melia; Roy W Beck;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Archives of ophthalmology     Volume:  129     ISSN:  1538-3601     ISO Abbreviation:  Arch. Ophthalmol.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-10     Completed Date:  2011-07-14     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  7706534     Medline TA:  Arch Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  603-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Surgical Procedures
Catheterization / economics
Cost-Benefit Analysis
Decision Trees
Health Care Costs*
Humans
Infant
Intubation / economics
Lacrimal Duct Obstruction / congenital,  economics*,  surgery*
Models, Economic*
Nasolacrimal Duct / surgery*
Ophthalmologic Surgical Procedures / economics*
Probability
Remission, Spontaneous
Treatment Outcome
Grant Support
ID/Acronym/Agency:
EY011751/EY/NEI NIH HHS; U10 EY011751/EY/NEI NIH HHS; U10 EY011751-12/EY/NEI NIH HHS; U10 EY011751-14/EY/NEI NIH HHS; U10 EY018810/EY/NEI NIH HHS; U10 EY018810-04/EY/NEI NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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