Evidence Based Medicine and Cost-effectiveness Analysis in Ophthalmology

Overview

Goal:
To make the reader familiar with the term evidence based medicine (EBM),to explain the principle of cost-effectiveness analysis (price-profit), and to showits usefulness to compare the effectiveness of different medical procedures.Method: Based on few examples, in this article the relevance and calculation ofimportant parameters of cost-effectiveness analysis (CE), as utility value (UV),quality adjusted life years (QALY) is explained. In addition, calculation of UV andQALY for the cataract surgery, including its complications, is provided.Results: According to this method, laser photocoagulation and cryocoagulation ofthe early stages of retinopathy of prematurity, treatment of amblyopia, cataractsurgery of one or both eyes, from the vitreoretinal procedures the early vitrectomyin cases of hemophtalmus in proliferative diabetic retinopathy or grid laserphotocoagulation in diabetic macular edemaor worsening of the visual acuity dueto the branch retinal vein occlusion belong to highly effective procedures. On theother hand, to the procedures with low cost effectiveness belongs the treating ofthe central retinal artery occlusion with anterior chamber paracentesis, as wellas with CO2 inhalation, or photodynamic therapy in choroidal neovascularizationin age-related macular degeneration with visual acuity of the better eye 20/200. Conclusion: Cost-effectiveness analysis is a new perspective method evaluatingsuccessfulness of medical procedure comparing the final effect with the financialcosts. In evaluation of effectiveness of individual procedures, three main aspectsare considered: subjective feeling of influence of the disease on the patient’s life,objective results of clinical examination and financial costs of the procedure.According to this method, the cataract surgery, as well as procedures in thepediatric ophthalmology belong to the most effective surgical methods.

Key words:
evidence based medicine, utility value, cost-effectiveness, cataract