- 刊名：Ophthalmology
- 出版年：2012
- 出版时间：December, 2012
- 年：2012
- 卷：119
- 期：12
- 页码：2558-2562
- 全文大小：213 K
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 ¡Ý20/32 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.