The Burden of Retinal Venous Occlusion: An Assessment of Fellow Eyes in 1000 Cases

Gary Brown; Janet Yoo; Melissa Brown; Adam Turpcu; Yamina Rajput; Wills Eye Hospital Retina Service Vein Occlusion Study Group

doi:10.1016/j.oret.2017.01.018

The Burden of Retinal Venous Occlusion: An Assessment of Fellow Eyes in 1000 Cases

Ophthalmol Retina. 2017 Sep-Oct;1(5):404-412. doi: 10.1016/j.oret.2017.01.018. Epub 2017 Mar 24.

Authors

Gary Brown¹, Janet Yoo², Melissa Brown³, Adam Turpcu⁴, Yamina Rajput⁴; Wills Eye Hospital Retina Service Vein Occlusion Study Group

Collaborators

Wills Eye Hospital Retina Service Vein Occlusion Study Group:
William Benson, Gary Brown, Mitchell Fineman, David Fischer, Sunir Garg, Omesh Gupta, Allen Ho, Jason Hsu, Richard Kaiser, Joseph Maguire, Carl Park, Carl Regillo, Arunan Sivalingam, Mark Spirn, William Tasman, James Vander

Affiliations

¹ Retina Service, Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania; Center for Value-Based Medicine, Hilton Head, South Carolina; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Eye Research Institute, Philadelphia, Pennsylvania. Electronic address: gbrown@valuebasedmedicine.com.
² Retina Service, Wills Eye Hospital, Jefferson Medical University, Philadelphia, Pennsylvania.
³ Center for Value-Based Medicine, Hilton Head, South Carolina; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Eye Research Institute, Philadelphia, Pennsylvania.
⁴ Healthcare Economics Unit, Genentech, Inc., South San Francisco, California.

PMID: 31047570
DOI: 10.1016/j.oret.2017.01.018

Abstract

Objective: To assess retinal vein occlusion (RVO) clinical features to create a simulation model quantifying the preference-based, patient value gain (benefit) and cost-utility (cost-effectiveness) of RVO therapy.

Design: Retrospective analysis data integrated with patient utilities and an ocular cost-utility model for RVO.

Participants: One thousand consecutive Wills Eye Hospital Retina Service RVO patients seen from January 2010 through April 2011.

Methods: Value-Based Medicine analysis assessing the demographic features and vision in affected eyes and fellow eyes of RVO patients.

Main outcome measures: Presenting vision, final vision, conversion incidence of fellow eyes to RVO, and patient value gain in quality-adjusted life-years (QALYs).

Results: Among 1000 patients, 332 (33.2%) presented with central retinal vein occlusion (CRVO), 53 (5.3%) with hemiretinal vein occlusion (HRVO), and 615 (61.5%) with branch retinal vein occlusion (BRVO). Mean follow-up for the entire RVO cohort was 3 years. One hundred and one patients (10.1%) had bilateral baseline RVO and, among the 826 unilateral cases seen more than once, 37 (4.5%) developed a fellow-eye RVO, a unilateral-to-bilateral conversion rate of 1.5%/year. Among the 101 baseline bilateral cases, 66% (66/101) had the same RVO variant bilaterally (CRVO/CRVO, HRVO/HRVO, or BRVO/BRVO). Mean CRVO baseline vision was 20/63^-2 and final vision was 20/63^-1 (P = 0.16). Thirty percent of patients had less than or equal to baseline fellow-eye vision. Within combined HRVO/BRVO cohorts, mean baseline vision was 20/50^-2 and final vision was 20/50⁺¹ (P = 0.0004). Thirty percent of patients also had less than or equal to baseline fellow-eye vision. The proportion of RVO patients with fellow-eye vision less than or equal to the RVO primary-eye baseline vision increased to 44% by year 16.

Conclusions: Thirty percent of all RVO patients had less than or equal to baseline vision in the fellow eye. Among unilateral RVO cases, 1.5%/year developed fellow-eye RVO. These findings have implications for cost-utility analysis, because bilateral vision loss yields greater QALY loss and an increased financial burden compared with unilateral loss. Referent to total therapeutic QALY gain (100%), if a treated RVO was always considered the better-seeing eye, the actual clinical scenario demonstrates that the average CRVO patient gains 38% as much value and the average HRVO/BRVO patient gains 37% as much.