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Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial.

Lookup NU author(s): Professor Laura Ternent, Professor Luke ValeORCiD, Professor David SteelORCiD


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Aim To determine whether internal limiting membrane (ILM) peeling is cost-effective compared with no peeling for patients with an idiopathic stage 2 or 3 full-thickness macular hole. Methods A cost-effectiveness analysis was performed alongside a randomised controlled trial. 141 participants were randomly allocated to receive macular-hole surgery, with either ILM peeling or no peeling. Health-service resource use, costs and quality of life were calculated for each participant. The incremental cost per quality-adjusted life year (QALY) gained was calculated at 6 months. Results At 6 months, the total costs were on average higher (424 pound, 95% CI -182 to 1045) in the No Peel arm, primarily owing to the higher reoperation rate in the No Peel arm. The mean additional QALYs from ILM peel at 6 months were 0.002 (95% CI 0.01 to 0.013), adjusting for baseline EQ-5D and other minimisation factors. A mean incremental cost per QALY was not computed, as Peeling was on average less costly and slightly more effective. A stochastic analysis suggested that there was more than a 90% probability that Peeling would be cost-effective at a willingness-to-pay threshold of 20 pound 000 per QALY. Conclusion Although there is no evidence of a statistically significant difference in either costs or QALYs between macular hole surgery with or without ILM peeling, the balance of probabilities is that ILM Peeling is likely to be a cost-effective option for the treatment of macular holes. Further long-term follow-up data are needed to confirm these findings.

Publication metadata

Author(s): Ternent L, Vale L, Boachie C, Burr JM, Lois N, Full-Thickness Macular Hole and Internal Limiting Membrane Peeling Study (FILMS) Group

Publication type: Article

Publication status: Published

Journal: British Journal of Opthalmology

Year: 2012

Volume: 96

Issue: 3

Pages: 438-443

Print publication date: 06/09/2011

ISSN (print): 0007-1161

ISSN (electronic): 1468-2079

Publisher: BMJ Publishing Group


DOI: 10.1136/bjophthalmol-2011-300402


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