• Laura Ternent, Luke Vale, Charles Boachie, Jennifer M Burr, Noemi Lois, and Full-Thickness Macular Hole and Internal Limiting Membrane Peeling Study (FILMS) Group.
• Institute of Health & Society, Newcastle University, Baddiley-Clarke Building, Newcastle Upon Tyne NE2 4AX, UK. laura.ternent@ncl.ac.uk
• Br J Ophthalmol. 2012 Mar 1; 96 (3): 438-43.

AimTo 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.MethodsA 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.ResultsAt 6 months, the total costs were on average higher (£424, 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 £20,000 per QALY.ConclusionAlthough 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.

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