Abstract
Background and PurposeTo evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness.MethodsElderly patients over 70 years old, who were diagnosed and underwent RRD surgery at Shanghai First People's Hospital, Shanghai Jiao Tong University, China, from January 1, 2009, through January 1, 2013. The participants received scleral buckling surgery and vitreous surgery with or without scleral buckling under retrobulbar anesthesia. We followed the patients for 1 year and collected best-corrected visual acuity (BCVA), vision-related quality of life, and direct medical costs data. Utility values elicited by time-trade-off were analyzed to determine the quality of life. Quality-adjusted life years (QALYs) gained in life expectancy were calculated and discounted at 3% annually. Costs per QALY gained were reported using the bootstrap method. Further analyses were made for two age groups, age 70–79 and age over 80 years. Sensitivity analyses were performed to test stability of the results.Results98 patients were included in the study. The BCVA significantly improved by 0.53±0.44 (Logarithm of the Minimum Angle of Resolution (logMAR)) at the 1-year postoperative time point (p<0.001). Utility values increased from 0.77 to 0.84 (p<0.001), and an average of 0.4 QALYs were gained in the life expectancy. Costs per QALY gained from the RRD surgery were 33,186 Chinese Yuan (CNY) (5,276 US dollars (USD))/QALY; 24,535 CNY (3,901 USD)/QALY for the age group of 70–79 years and 71,240 CNY (11,326 USD)/QALY for the age group over 80 years.ConclusionsRRD surgery improved the visual acuity and quality of life in the elderly patients over 70 years old. According to the World Health Organization’s recommendation, at a threshold of willingness to pay of 115,062 CNY (18,293 USD)/QALY, RRD surgery is cost effective in the elderly patients.
Highlights
Rhegmatogenous retinal detachment (RRD) is the most common type of retinal detachment, and it severely threatens visual acuity and vision-related quality of life [1,2,3]
This study presented the outcomes of rhegmatogenous retinal detachment (RRD) surgery in terms of visual acuity and visionrelated quality of life and calculated its cost-effectiveness in an elderly population
The best-corrected visual acuity significantly improved at the 3month post-operative time point compared with the preoperative time
Summary
Rhegmatogenous retinal detachment (RRD) is the most common type of retinal detachment, and it severely threatens visual acuity and vision-related quality of life [1,2,3]. Proper and timely treatments, such as scleral buckling surgery and vitreous surgery, can largely restore visual acuity and permit a certain degree of improvement in vision-related quality of life [4], [5]. Two recent studies performed in America calculated the costs for the two types of surgery varying from 4,048 USD to 7,940 USD [8], [9]. To evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness
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