Tags

Type your tag names separated by a space and hit enter

Cost-effectiveness analysis of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.
Ophthalmology. 2012 Aug; 119(8):1679-84.O

Abstract

OBJECTIVE

Perform a cost-effectiveness analysis of the treatment of diabetic macular edema (DME) with ranibizumab plus prompt or deferred laser versus triamcinolone plus prompt laser. Data for the analysis were drawn from reports of the Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol I.

DESIGN

Computer simulation based on Protocol I data. Analyses were conducted from the payor perspective.

PARTICIPANTS

Simulated participants assigned characteristics reflecting those seen in Protocol I.

METHODS

Markov models were constructed to replicate Protocol I's 104-week outcomes using a microsimulation approach to estimation. Baseline characteristics, visual acuity (VA), treatments, and complications were based on Protocol I data. Costs were identified by literature search. One-way sensitivity analysis was performed, and the results were validated against Protocol I data.

MAIN OUTCOME MEASURES

Direct cost of care for 2 years, change in VA from baseline, and incremental cost-effectiveness ratio (ICER) measured as cost per additional letter gained from baseline (Early Treatment of Diabetic Retinopathy Study).

RESULTS

For sham plus laser (S+L), ranibizumab plus prompt laser (R+pL), ranibizumab plus deferred laser (R+dL), and triamcinolone plus laser (T+L), effectiveness through 104 weeks was predicted to be 3.46, 7.07, 8.63, and 2.40 letters correct, respectively. The ICER values in terms of dollars per VA letter were $393 (S+L vs. T+L), $5943 (R+pL vs. S+L), and $20 (R+dL vs. R+pL). For pseudophakics, the ICER value for comparison triamcinolone with laser versus ranibizumab with deferred laser was $14 690 per letter gained. No clinically relevant changes in model variables altered outcomes. Internal validation demonstrated good similarity to Protocol I treatment patterns.

CONCLUSIONS

In treatment of phakic patients with DME, ranibizumab with deferred laser provided an additional 6 letters correct compared with triamcinolone with laser at an additional cost of $19 216 over 2 years. That would indicate that if the gain in VA seen at 2 years is maintained in subsequent years, then the treatment of phakic patients with DME using ranibizumab may meet accepted standards of cost-effectiveness. For pseudophakic patients, first-line treatment with triamcinolone seems to be the most cost-effective option.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22503301

Citation

Dewan, Vinay, et al. "Cost-effectiveness Analysis of Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema." Ophthalmology, vol. 119, no. 8, 2012, pp. 1679-84.
Dewan V, Lambert D, Edler J, et al. Cost-effectiveness analysis of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2012;119(8):1679-84.
Dewan, V., Lambert, D., Edler, J., Kymes, S., & Apte, R. S. (2012). Cost-effectiveness analysis of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology, 119(8), 1679-84. https://doi.org/10.1016/j.ophtha.2012.01.049
Dewan V, et al. Cost-effectiveness Analysis of Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema. Ophthalmology. 2012;119(8):1679-84. PubMed PMID: 22503301.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. AU - Dewan,Vinay, AU - Lambert,Dennis, AU - Edler,Joshua, AU - Kymes,Steven, AU - Apte,Rajendra S, Y1 - 2012/04/13/ PY - 2011/07/27/received PY - 2012/01/25/revised PY - 2012/01/26/accepted PY - 2012/4/17/entrez PY - 2012/4/17/pubmed PY - 2012/10/26/medline SP - 1679 EP - 84 JF - Ophthalmology JO - Ophthalmology VL - 119 IS - 8 N2 - OBJECTIVE: Perform a cost-effectiveness analysis of the treatment of diabetic macular edema (DME) with ranibizumab plus prompt or deferred laser versus triamcinolone plus prompt laser. Data for the analysis were drawn from reports of the Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol I. DESIGN: Computer simulation based on Protocol I data. Analyses were conducted from the payor perspective. PARTICIPANTS: Simulated participants assigned characteristics reflecting those seen in Protocol I. METHODS: Markov models were constructed to replicate Protocol I's 104-week outcomes using a microsimulation approach to estimation. Baseline characteristics, visual acuity (VA), treatments, and complications were based on Protocol I data. Costs were identified by literature search. One-way sensitivity analysis was performed, and the results were validated against Protocol I data. MAIN OUTCOME MEASURES: Direct cost of care for 2 years, change in VA from baseline, and incremental cost-effectiveness ratio (ICER) measured as cost per additional letter gained from baseline (Early Treatment of Diabetic Retinopathy Study). RESULTS: For sham plus laser (S+L), ranibizumab plus prompt laser (R+pL), ranibizumab plus deferred laser (R+dL), and triamcinolone plus laser (T+L), effectiveness through 104 weeks was predicted to be 3.46, 7.07, 8.63, and 2.40 letters correct, respectively. The ICER values in terms of dollars per VA letter were $393 (S+L vs. T+L), $5943 (R+pL vs. S+L), and $20 (R+dL vs. R+pL). For pseudophakics, the ICER value for comparison triamcinolone with laser versus ranibizumab with deferred laser was $14 690 per letter gained. No clinically relevant changes in model variables altered outcomes. Internal validation demonstrated good similarity to Protocol I treatment patterns. CONCLUSIONS: In treatment of phakic patients with DME, ranibizumab with deferred laser provided an additional 6 letters correct compared with triamcinolone with laser at an additional cost of $19 216 over 2 years. That would indicate that if the gain in VA seen at 2 years is maintained in subsequent years, then the treatment of phakic patients with DME using ranibizumab may meet accepted standards of cost-effectiveness. For pseudophakic patients, first-line treatment with triamcinolone seems to be the most cost-effective option. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/22503301/Cost_effectiveness_analysis_of_ranibizumab_plus_prompt_or_deferred_laser_or_triamcinolone_plus_prompt_laser_for_diabetic_macular_edema_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(12)00110-8 DB - PRIME DP - Unbound Medicine ER -