title: Cost-effectiveness of treatment of diabetic macular edema.
abstract: BACKGROUND
  Macular edema is the most common cause of vision loss among patients with diabetes.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of different treatments of diabetic macular edema (DME).
  
  
  METHODS
  Markov model.
  
  
  METHODS
  Published literature and expert opinion.
  
  
  METHODS
  Patients with clinically significant DME.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both.
  
  
  METHODS
  Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  All treatments except laser monotherapy substantially reduced costs, and all treatments except triamcinolone monotherapy increased QALYs. Laser treatment plus a VEGF inhibitor achieved the greatest benefit, gaining 0.56 QALYs at a cost of $6975 for an ICER of $12 410 per QALY compared with laser treatment plus triamcinolone. Monotherapy with a VEGF inhibitor achieved similar outcomes to combination therapy with laser treatment plus a VEGF inhibitor. Laser monotherapy and triamcinolone monotherapy were less effective and more costly than combination therapy.
  
  
  RESULTS
  VEGF inhibitor monotherapy was sometimes preferred over laser treatment plus a VEGF inhibitor, depending on the reduction in quality of life with loss of visual acuity. When the VEGF inhibitor bevacizumab was as effective as ranibizumab, it was preferable because of its lower cost.
  
  
  CONCLUSIONS
  Long-term outcome data for treated and untreated diseases are limited.
  
  
  CONCLUSIONS
  The most effective treatment of DME is VEGF inhibitor injections with or without laser treatment. This therapy compares favorably with cost-effective interventions for other conditions.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Suzann
authors.initials: S
authors.lastname: Pershing
authors.forename: Eva A
authors.initials: EA
authors.lastname: Enns
authors.forename: Brian
authors.initials: B
authors.lastname: Matesic
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
mesh_terms: D060433:Administration, Ophthalmic; D000893:Anti-Inflammatory Agents / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000150:complications / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000191:economics*; D008269:Macular Edema / Q000150:complications / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D040262:Receptors, Vascular Endothelial Growth Factor / Q000191:economics / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014221:Triamcinolone / Q000191:economics* / Q000627:therapeutic use; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors* / Q000191:economics; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D014221:Triamcinolone; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor