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Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial
  1. Laura Ternent1,
  2. Luke Vale1,
  3. Charles Boachie2,
  4. Jennifer M Burr2,
  5. Noemi Lois3,
  6. for the Full-Thickness Macular Hole and Internal Limiting Membrane Peeling Study (FILMS) Group
  1. 1Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
  2. 2Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  3. 3Department of Ophthalmology, Grampian University Hospitals-NHS Trust, Aberdeen, UK
  1. Correspondence to Laura Ternent, Institute of Health & Society, Newcastle University, Baddiley-Clarke Building, Newcastle Upon Tyne NE2 4AX, UK; laura.ternent{at}


Aim To 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.

Methods A 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.

Results At 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.

Conclusion Although 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.

  • Clinical trial
  • macula
  • retina
  • treatment surgery
  • vitreous
  • epidemiology
  • choroid
  • neovascularisation
  • imaging
  • treatment lasers
  • treatment surgery

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  • Funding Chief Scientist Office of the Scottish Government Health Directorates.

  • Correction notice This article has been corrected since it was published Online First. The authors' acknowledgements have been added.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Multicentre Research Ethics Committee, Local Ethics Committees and local hospital trusts of each participating centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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