Search

Purpose: To perform a cost-utility analysis and comparison between pneumatic retinopexy (PR) and pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair., Design: A cost-utility analysis using decision analysis., Participants: There were no participants., Methods: A decision analysis model was constructed based on results from the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial to calculate the costs, lifetime usefulness, and lifetime cost per quality-adjusted life year (QALY) for the treatment of RRD with PR or PPV. Data from the Centers for Medicare and Medicaid Services were used to calculate the associated adjusted costs in facility and nonfacility practice settings., Main Outcome Measures: Cost of intervention, utility gain over natural history, QALY gained, and cost per QALY., Results: The total imputed costs (all in 2019 United States dollars) for primary repair of RRD in facility and nonfacility settings were $4451 and $2456, respectively, in the PR group and $7108 and $4514, respectively, in the PPV group. The estimated lifetime QALYs gained were 5.9 and 5.4 in the PR and PPV groups, respectively. The cost per QALY for facility and nonfacility settings was $751 and $414, respectively, in the PR group and $1312 and $833, respectively, in the PPV group., Conclusions: Cost-utility analysis of both PR and PPV demonstrated excellent results for both methods for RRD repair, with the metrics for PR somewhat more favorable independent of the practice settings (facility or nonfacility based)., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To provide insight into the preoperative factors that affect outcome after pneumatic retinopexy (PR) for treatment of primary rhegmatogenous retinal detachment repair. Additionally, we sought to analyze the cost of rhegmatogenous retinal detachment repair in the United States to determine potential cost savings with pneumatic retinopexy., Design: Single-center, retrospective, observational consecutive case series and third party payer-perspective comparative cost analysis., Participants: We included 141 eyes undergoing pneumatic retinopexy for the treatment of primary rhegmatogenous retinal detachment., Methods: Preoperative characteristics, anatomic outcomes, and best-available visual acuity were collected. Anatomic and visual outcomes were analyzed based on the presence of selected preoperative factors. The primary cohort was divided into 2 groups based on preoperative characteristics: (1) traditional pneumatic retinopexy and (2) nontraditional pneumatic retinopexy. Comparative cost analyses were performed between pneumatic retinopexy, scleral buckling, and vitrectomy., Main Outcome Measures: Anatomic and visual outcomes at 6 months., Results: Overall anatomic success was 78.7% and visual acuity improved significantly (logarithm of the minimum angle of resolution [logMAR] 0.48-0.25; P <0.005). A 97.6% final anatomic success rate was achieved. Anatomic outcomes were similar between traditional versus nontraditional (84.1% vs 74.4%; P = 0.16), phakic versus pseudophakic (79.1% vs 78.0%; P = 0.88), and macula-on versus macula-off (77.9% vs 81.1%; P = 0.68) groups. Anatomic failure was predicted by the presence of an inferior retinal break (P <0.005) or visible vitreous traction on a retinal break (P = 0.04). Visual outcomes were similar between each of the traditional versus nontraditional (logMAR 0.21 vs 0.27; P >0.05) and phakic versus pseudophakic groups (logMAR 0.23 vs 0.28; P >0.05). Visual outcomes were better in macula-on detachments compared with those in which the macula was detached (logMAR 0.18 vs 0.42; P <0.005). Annual health care cost savings in the United States ranging from $6 to $30 million are theoretically possible by increasing pneumatic retinopexy utilization from the current rate of 15% to 20%-35%., Conclusions: Pneumatic retinopexy is an effective treatment modality for primary rhegmatogenous retinal detachment. Anatomic and visual outcomes are similar for traditional and nontraditional preoperative inclusion criteria, as well as phakic and pseudophakic eyes. Inferior breaks and visible vitreous traction on a tear predicted failure. Increased utilization of pneumatic retinopexy would achieve significant cost savings while maintaining outcomes., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Cutaneous cryosurgery refers to localized application of freezing temperatures to achieve destruction of skin lesions. It can be used to treat a broad range of benign and premalignant skin conditions, and certain malignant skin conditions, with high cure rates. Cellular destruction is accomplished by delivery of the cryogen via dipstick, probe, or spray techniques. It is widely used in primary care because of its safety, effectiveness, low cost, ease of use, good cosmetic results, and lack of need for anesthesia. Cryosurgery is as effective as alternative therapies for most cases of molluscum contagiosum, dermatofibromas, keloids, and plantar or genital warts. It is a more effective cure for common warts than salicylic acid or observation. Cryosurgery is generally the treatment of choice for actinic keratosis. Contraindications to cryosurgery include cryofibrinogenemia, cryoglobulinemia, Raynaud disease, agammaglobulinemia, and multiple myeloma. Complications from cryosurgery include hypopigmentation and alopecia, and can be avoided by limiting freeze times to less than 30 seconds. Referral to a dermatologist should be considered in cases of diagnostic uncertainty or for treatment of skin cancer, which requires larger amounts of tissue destruction, resulting in higher complication rates.

How much are you paying out in costs for hysterectomies, and do the women who have this procedure really need it? Several physicians argue that dysfunctional uterine bleeding, the main reason why women undergo hysterectomies, is a perfect candidate for disease management.