Clinical Applications of Cost Analysis of Diabetic Macular Edema Treatments.

Oct 2012

Smiddy WE.

Source

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: 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 less then twenty over two hundred. at least as much visual benefit for intravitreal triamcinolone versus laser; a subgroup analysis of pseudophakic DME eyes shows equivalent visual results with anti-VEGF treatment versus laser combined with IVTA, eyes with VA of greater then or equal to twenty over thirty two,  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 forty percent to eighty eight percent..

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.

Elsevier