Scleral buckle is more cost effective than vitrectomy for phakic patients

Image: PD Retinal detachment in VPL

1. Scleral buckle was less expensive than pars plana vitrectomy by 10.7% in phakic patients.

2. Pars plana vitrectomy was more cost effective than scleral buckle by 12.1% for pseudophakic or aphakic patients.

Evidence Rating Level: 2 (Good) 

Study Rundown: This study demonstrates that for a specific subset of retinal detachments, surgically inserting a scleral buckle (SB) is more cost effective than a pars plana vitrectomy (PPV) if the patient still has his or her natural lens. If the patient has already undergone cataract surgery, PPV is economically optimal. Given today’s climate of cost control, this study provides the ophthalmology community with important cost analyses regarding two clinically comparable procedures, and would seem to provide additional guidance as to specific indications of each. Limitations include the fact that based on the utilized studies, it was unclear how many patients required revision surgery, which would contribute to the economic burden. There was an additional bias in that anesthesia costs were reported to be equal, although PPV usually involves longer surgical times. In addition, the conclusions that were drawn only apply to isolated rhegmatogenous retinal detachments without any additional retinal disease.

Click to read the study in American Journal of Ophthalmology

Relevant Reading: Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study

In-Depth [retrospective study]: This study attempted to assess the difference in costs associated with two comparable treatments used to repair retinal detachments, scleral buckle (SB) and pars plana vitrectomy (PPV). Previously published randomized controlled trials were used to calculate costs due to initial surgery, subsequent procedures, and cataract removal. Patients were divided by the status of their lens – phakic (natural lens intact), pseudophakic (artificial intraocular lens present), or aphakic (no lens present). SB was less expensive than PPV by 10.7% in phakic patients. However, PPV was more cost effective than SB by 12.1% in pseudophakic or aphakic patients. Patients receiving SB were previously shown to be more likely to require subsequent procedures, and pseudophakic or aphakic patients were more likely to require such procedures, thereby leading to the higher cost in such patients. These data were quite robust when subjected to sensitivity analysis.

By Swarup Swaminathan and Andrew Bishara

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