Purpose: To perform a cost-utility analysis comparing primary pars plana vitrectomy within 24-hours (VIT) with primary non-surgical vitreous biopsy (TAP) for the management of endophthalmitis. Method: Retrospective cost-utility analysis using decision-tree modelling. Data from the Victorian Endophthalmitis Registry was used to model outcome probabilities and cost from a third-payer perspective. Medicare data were used to calculate costs in a hospital-based setting ($AUD). Cost-utility was based on preserved visual utility (VA) and cost per quality-adjusted life year (QALY). Results: Two hundred and six eyes were identified between 1 January 2011 to 2021. Thirty-six eyes received VIT and 170 eyes received TAP. 17 eyes in the TAP group required delayed vitrectomy. Mean incident ages were 76.29 years (45% Female) in the VIT group and 74.28 years (53% Female) in the TAP group. The imputed costs were $1523 and $454 for VIT and TAP, with additional per-night admission costs of $1177. The mean presenting vs discharge LogMAR VA of endophthalmitis was 2.24 vs 1.25 for the VIT group and 1.88 vs 1.03 for the TAP group. The mean duration of admission was 4.33 (VIT) and 4.04 nights (TAP). Total costs per admission were $6929.41 and $5361.22 for VIT and TAP respectively. Estimated lifetime QALYs gained were 2.23 (VIT) and 2.72 (TAP). The final costs derived per QALY were $3107 (VIT) and $1971 (TAP). Conclusion: VIT and TAP are cost-effective per gained QALY, though TAP provided superior cost-utility. A prospective randomised trial is indicated to overcome baseline differences of worse presenting VA and prognosis eyes receiving vitrectomy.
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