Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 262-269 (doi:10.1542/peds.2007-2725)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kamholz, K. L.
Right arrow Articles by Zupancic, J. A. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kamholz, K. L.
Right arrow Articles by Zupancic, J. A. F.
Related Collections
Right arrow Premature & Newborn
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Cost-effectiveness of Early Treatment for Retinopathy of Prematurity

Karen L. Kamholz, MD, MPHa,b, Cynthia H. Cole, MD, MPHa, James E. Gray, MD, MSc,d,e and John A. F. Zupancic, MD, ScDc,d

a Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
b Boston University School of Medicine, Boston, Massachusetts
c Department of Neonatology
e Division of Clinical Computing, Beth Israel Deaconess Medical Center, Boston, Massachusetts
d Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts

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 $14200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40000 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 $6200 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.

Key Words: infant • newborn • retinopathy of prematurity • costs and cost analysis

Abbreviations: ROP—retinopathy of prematurity • ETROP—Early Treatment for Retinopathy of Prematurity • ET—early treatment • QALY—quality-adjusted life-year

Accepted Apr 22, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?