A Randomized Trial Comparing the Cost-effectiveness of 2 Approaches for Treating Unilateral Nasolacrimal Duct Obstruction

Abstract

To compare the cost-effectiveness of two approaches for treating unilateral nasolacrimal duct obstruction (NLDO) 163 infants 6 to <10 months old with unilateral NLDO were randomly assigned to immediate office-based nasolacrimal duct probing (N=82) or to six months of observation/non-surgical management (N=81) followed by facility-based probing for persistent symptoms. Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) upon masked examination at 18 months of age. Cost of treatment between randomization and 18 months of age included costs for all surgeries and medications. In the observation/deferred facility probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%, 95% confidence interval (CI)=54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility probing group underwent surgery, 4 of whom were operated within the initial 6 months. At 18 months of age, 69 (92%) of 75 immediate office probing group patients were treatment successes, compared with 58 (82%) of 71 observation/deferred facility probing group patients (difference=10%, 95%CI=−1% to 21%). The average cost of treatment was $562 in the immediate office probing group compared with $701 in the observation/deferred facility probing group (difference=−$139, 95%CI=−$377 to $94). The immediate office probing group had 3.0 fewer months of symptoms (95%CI=−1.8 to −4.0). The immediate office probing approach is likely more cost effective than observation followed by deferred facility probing if needed. Adoption of the immediate office probing approach would result in probing about two-thirds of infants who would have resolved with 6 months of non-surgical management, but would largely avoid the need for probing under general anesthesia. Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option. The study is listed on www.clinicaltrials.gov (NCT00780741).