Clinical applications of cost analysis of diabetic macular edema treatments.
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.


METHODS
A model of resource use, outcomes, and cost-effectiveness and utility.


METHODS
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.


METHODS
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.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33101-6880, USA. wsmiddy@med.miami.edu
William E
WE
Smiddy
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D017075:Laser Coagulation / Q000191:economics; D008269:Macular Edema / Q000191:economics* / Q000628:therapy; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D040262:Receptors, Vascular Endothelial Growth Factor; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000191:economics; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000191:economics; D014786:Vision Disorders / Q000191:economics* / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology
D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D014222:Triamcinolone Acetonide