Cost-effectiveness analysis of endoscopic dacryocystorhinostomy using Markov modelling

Jenny Q Hu; Clara J Men; Natalie A Afshari; Catherine Y Liu; Bobby S Korn; Don O Kikkawa

doi:10.1016/j.jcjo.2023.03.005

Cost-effectiveness analysis of endoscopic dacryocystorhinostomy using Markov modelling

Can J Ophthalmol. 2024 Jun;59(3):e233-e238. doi: 10.1016/j.jcjo.2023.03.005. Epub 2023 Mar 28.

Authors

Jenny Q Hu¹, Clara J Men², Natalie A Afshari³, Catherine Y Liu⁴, Bobby S Korn⁵, Don O Kikkawa⁵

Affiliations

¹ Shiley Eye Institute, University of California San Diego, La Jolla, CA. Electronic address: jqh003@health.ucsd.edu.
² Byers Eye Institute, Stanford University, Palo Alto, CA.
³ Shiley Eye Institute, University of California San Diego, La Jolla, CA.
⁴ Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California San Diego, La Jolla, CA.
⁵ Shiley Eye Institute, University of California San Diego, La Jolla, CA; Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California San Diego, La Jolla, CA; Division of Plastic Surgery, Department of Surgery, University of California San Diego, La Jolla, CA.

PMID: 37001560
DOI: 10.1016/j.jcjo.2023.03.005

Abstract

Objective: To determine the cost-effectiveness of endoscopic dacryocystorhinostomy (DCR).

Methods: We constructed a Markov model in which patients with nasolacrimal duct obstruction received endoscopic DCR or no surgery. Incremental cost-effectiveness ratios, 1-way sensitivity analyses, and probabilistic sensitivity analyses were used to evaluate for model sensitivity to multiple model inputs.

Results: Endoscopic DCR was found to be cost-effective with an incremental cost-effectiveness ratio of US$2162 per quality-adjusted life-year. The model was most sensitive to the health utility deduction from epiphora. Probabilistic sensitivity analysis found endoscopic DCR to be cost-effective over no surgery 93.7% of the time.

Conclusions: Endoscopic DCR is a cost-effective treatment for patients with epiphora. The model is very sensitive to the negative effect epiphora has on quality of life. With the advancement of health care technology and surgical techniques, the success rates of endoscopic DCR continue to improve and to be an even more efficacious and economical treatment for nasolacrimal duct obstruction.

MeSH terms

Cost-Benefit Analysis*
Cost-Effectiveness Analysis
Dacryocystorhinostomy* / economics
Dacryocystorhinostomy* / methods
Endoscopy* / economics
Endoscopy* / methods
Female
Health Care Costs
Humans
Lacrimal Duct Obstruction* / economics
Lacrimal Duct Obstruction* / therapy
Male
Markov Chains*
Middle Aged
Nasolacrimal Duct* / surgery
Quality of Life*
Quality-Adjusted Life Years*