PURPOSE To evaluate costs and cost-utility of early vitrectomy (pars plana vitrectomy [PPV]) compared with panretinal photocoagulation (PRP) and intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR) without diabetic macular edema. DESIGN A decision analysis model of cost-utility. PARTICIPANTS There were no participants. METHODS A decision analysis was based on results from the Diabetic Retinopathy Clinical Research Network Protocol S comparing treatment of PRP with IVR (0.3 mg) in PDR without incident macular edema to model the total 2-year costs and outcomes for each treatment scenario. These values were compared with the 2-year hypothetical costs of early PPV for PDR. Centers for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility setting. Cost-utility was calculated on the basis of the preserved visual utility and estimated life years remaining. In addition, costs for lifetime treatment were modeled for all scenarios and used to calculate lifetime quality-adjusted life years (QALY) costs for each scenario. Sensitivity analyses were performed to evaluate the impact of the model's assumptions. MAIN OUTCOME MEASURES Cost of treatment, utility, and cost per QALY. RESULTS The modeled cost per QALY of treatment for PDR for 2 years of utility in the facility (nonfacility) setting was $163 988 ($102 559) in the PRP group, $436 992 ($326 424) in the IVR group, and $181 144 ($107 965) in the PPV group. Sensitivity analysis showed that both IVR and PPV groups would have equivalent costs per QALY over the first 2 years if 78% (facility) and 80% (nonfacility) of patients in the PPV group required additional treatment with IVR (at the dose of 10.1 injections as in Protocol S). Beyond 2 years, the cost per QALY in the facility (nonfacility) setting was calculated as $61 695 ($21 752) in the PRP group, $338 348 ($239 741) in the IVR group, and $63 942 ($22 261) in the PPV group. CONCLUSIONS Early PPV as a strategy for treatment of PDR without macular edema demonstrates cost-utility similar to management with PRP and more favorable cost-utility compared with IVR in the short term. This advantage over IVR continues when lifetime costs are factored.

中文翻译：

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早期玻璃体切除术与全视网膜光凝和玻璃体内雷珠单抗治疗增生性糖尿病性视网膜病变的成本评估。

目的评估早期玻璃体切除术（pars Plana玻璃体切除术[PPV]）与全视网膜光凝术（PRP）和玻璃体内兰尼单抗（IVR）相比无糖尿病性黄斑水肿的增生性糖尿病视网膜病变（PDR）的成本和成本效益。设计成本效用的决策分析模型。参加者没有参加者。方法决策分析基于糖尿病视网膜病变临床研究网络协议S的结果，该结果比较了PDR和IVR（0.3 mg）在未发生黄斑水肿的PDR中的治疗情况，以模拟每种治疗方案的2年总费用和结果。将这些值与PDR的早期PPV的2年假想成本进行了比较。医疗保险和医疗补助服务中心的数据用于在医院/设施和非设施环境中计算相关的建模成本。成本效用是根据保留的视觉效用和估计的剩余使用寿命计算的。此外，为所有方案建模了终生治疗费用，并用于计算每种方案的终生质量调整生命年（QALY）费用。进行了敏感性分析，以评估模型假设的影响。主要观察指标：治疗，公用事业的费用以及每QALY的费用。结果在设施（非设施）设置中使用2年的PDR，每QALY治疗的模型化成本在PRP组为163 988美元（102 559美元），在IVR组为436 992美元（326 424美元），以及181 144美元（107美元）。 PPV组中的965）。敏感性分析表明，如果PPV组中78％（设施）和80％（非设施）的患者需要接受IVR的进一步治疗（以10.1注射剂量），则IVR和PPV组在头2年的每QALY费用相等。如协议S）中所述。超过2年，设施（非设施）设置中每个QALY的成本计算为：PRP组为61 695美元（21 752美元），IVR组为338 348美元（239 741美元），PPV为63 942美元（22 261美元）团体。结论早期PPV作为治疗无黄斑水肿的PDR的策略显示出与PRP管理相似的成本-效用，并且与IVR相比，在短期内具有更有利的成本-效用。如果将使用寿命成本考虑在内，则与IVR相比，这种优势仍将继续。在设施（非设施）设置中，每个QALY的费用计算为：PRP组为61 695美元（21 752美元），IVR组为338 348美元（239 741美元），PPV组为63 942美元（22 261美元）。结论早期PPV作为治疗无黄斑水肿的PDR的策略显示出与PRP管理相似的成本-效用，并且与IVR相比，在短期内具有更有利的成本-效用。如果将使用寿命成本考虑在内，则与IVR相比，这种优势仍将继续。在设施（非设施）设置中，每个QALY的费用计算为：PRP组为61 695美元（21 752美元），IVR组为338 348美元（239 741美元），PPV组为63 942美元（22 261美元）。结论早期PPV作为治疗无黄斑水肿的PDR的策略显示出与PRP管理相似的成本-效用，并且与IVR相比，在短期内具有更有利的成本-效用。如果将使用寿命成本考虑在内，则与IVR相比，这种优势仍将继续。