William E Smiddy1. 1. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33101-6880, USA. wsmiddy@med.miami.edu
Abstract
OBJECTIVE: To apply cost-benefit analyses in specific circumstances in which the results of multiple modalities of treating diabetic macular edema (DME) are similar, as a basis for considering economic ramifications in clinically relevant applications. DESIGN: A model of resource use, outcomes, and cost-effectiveness and utility. PARTICIPANTS: There were no participants. METHODS: Results from published clinical trials (index studies) of laser, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents, and vitrectomy trials were used to ascertain visual benefit and clinical protocols of patients with DME. Calculations followed from the costs of 1 year of treatment for each modality and the visual benefits as ascertained. MAIN OUTCOME MEASURES: Visual acuity (VA) saved, cost of therapy, cost per line saved, cost per line-year saved, and costs per quality-adjusted life years (QALYs) saved. RESULTS: Four specific situations were observed or analyzed: (1) Treatment results for DME causing VA loss <20/200 show at least as much visual benefit for intravitreal triamcinolone (IVTA) versus laser; (2) a subgroup analysis of pseudophakic DME eyes shows equivalent visual results with anti-VEGF treatment versus laser combined with IVTA; (3) eyes with VA of ≥ 20/32 have been studied only by laser; and (4) less frequent use of aflibercept yields equivalent visual results as more frequent treatment. When the results are equivalent, opting for the less-expensive treatment option could yield cost savings of 40% to 88%. CONCLUSIONS: Cost-effectiveness analyses can be clinically relevant and may be considered when formulating and applying treatment strategies for some subsets of patients with DME. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
OBJECTIVE: To apply cost-benefit analyses in specific circumstances in which the results of multiple modalities of treating diabetic macular edema (DME) are similar, as a basis for considering economic ramifications in clinically relevant applications. DESIGN: A model of resource use, outcomes, and cost-effectiveness and utility. PARTICIPANTS: There were no participants. METHODS: Results from published clinical trials (index studies) of laser, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents, and vitrectomy trials were used to ascertain visual benefit and clinical protocols of patients with DME. Calculations followed from the costs of 1 year of treatment for each modality and the visual benefits as ascertained. MAIN OUTCOME MEASURES: Visual acuity (VA) saved, cost of therapy, cost per line saved, cost per line-year saved, and costs per quality-adjusted life years (QALYs) saved. RESULTS: Four specific situations were observed or analyzed: (1) Treatment results for DME causing VA loss <20/200 show at least as much visual benefit for intravitreal triamcinolone (IVTA) versus laser; (2) a subgroup analysis of pseudophakic DME eyes shows equivalent visual results with anti-VEGF treatment versus laser combined with IVTA; (3) eyes with VA of ≥ 20/32 have been studied only by laser; and (4) less frequent use of aflibercept yields equivalent visual results as more frequent treatment. When the results are equivalent, opting for the less-expensive treatment option could yield cost savings of 40% to 88%. CONCLUSIONS: Cost-effectiveness analyses can be clinically relevant and may be considered when formulating and applying treatment strategies for some subsets of patients with DME. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Authors: Victor Manuel Villegas; Aaron Samuel Gold; Andrea Wildner; Azeema Latiff; Timothy Garrett Murray Journal: Int J Ophthalmol Date: 2016-05-18 Impact factor: 1.779
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