Study evaluates cost-effectiveness of strategies to treat infant tear-duct obstruction

May 9, 2011

When infants' tear ducts are blocked, the decision about when to intervene and the cost-effectiveness of doing so depend on how likely it is the problem will self-resolve, according to a report in the May issue of Archives of Ophthalmology.

It is not uncommon for to be born with blockage of the tear ducts, a condition known as congenital nasolacrimal duct obstruction (NLDO). In many cases, the condition will resolve spontaneously by the time a child is one year old. For affected infants at least six months old, physicians can try to open the duct in the office under , or they can pursue watchful waiting and, if spontaneous resolution does not occur, perform a deferred intervention (probing of the duct) in a surgical facility.

Both options have risks and benefits, note the authors. Consequently, "controversy remains among surgeons as to the preferred approach." Part of the challenge is taking into account the rate of spontaneous resolution, which ranges from 32 percent to 95 percent.

Using modeling and analysis, Kevin D. Frick, Ph.D., from The Johns Hopkins University, Baltimore, and colleagues calculated how spontaneous resolution rates, intervention success rates, and intervention setting affect costs and outcomes. They used data from the 2009 Fee Schedule, a 2008 study of NLDO treatment conducted by the Pediatric Investigator Group, and information from the scientific literature. They constructed decision trees for two options—immediate office-based probing surgery to clear the blockage, versus watchful waiting and deferred facility-based probing surgery as needed. Analytical variables included the percentage of cases resolving spontaneously and the cost of treating the condition in different types of facilities.

Under the assumption that the spontaneous resolution rate is 75 percent, immediate office-based duct-probing surgery would be more expensive than waiting ($771 vs. $641) and slightly less effective than delayed facility-based probing surgery. However, under the assumption that spontaneous resolution rates are below 68 percent, immediate office-based probing surgery costs less than deferred facility-based surgery, but is slightly less effective. Immediate intervention, when 50 percent to 90 percent of cases are expected to resolve on their own, may result in a shorter duration of symptoms. Varying the setting of intervention affected the cost. A change in the expected spontaneous resolution rate from 68 percent to 60 percent would increase the cost of success from a wait-and-see approach to $5,000. The authors conclude, "A more precise estimate of the spontaneous resolution rate of NLDO is critical for establishing which approach is the clinically or economically obvious choice or whether trade-offs between costs and outcomes need to be considered carefully."

More information: Arch Ophthalmol. 2011;129[5]:603-609

Related Stories

Recommended for you

Monkeys in Asia harbor virus from humans, other species

November 19, 2015

When it comes to spreading viruses, bats are thought to be among the worst. Now a new study of nearly 900 nonhuman primates in Bangladesh and Cambodia shows that macaques harbor more diverse astroviruses, which can cause ...

One-step test for hepatitis C virus infection developed

November 14, 2015

UC Irvine Health researchers have developed a cost-effective one-step test that screens, detects and confirms hepatitis C virus (HCV) infections. Dr. Ke-Qin Hu, director of hepatology services, will present findings at the ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.