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Cost-effectiveness of various interventions for newly diagnosed diabetic macular edema.
Ophthalmology. 2013 Sep; 120(9):1835-42.O

Abstract

OBJECTIVE

Anti-vascular endothelial growth factor therapies have revolutionized the treatment of clinically significant diabetic macular edema (CSDME); yet these agents are expensive, and whether they are cost-effective is unclear. The purpose of this study is to determine the most cost-effective treatment option for patients with newly diagnosed CSDME: focal laser photocoagulation alone (L), focal laser plus intravitreal ranibizumab (L+R), focal laser plus intravitreal bevacizumab (L+B), or focal laser plus intravitreal triamcinolone (L+T) injections.

DESIGN

Cost-effectiveness analysis.

PARTICIPANTS

Hypothetical cohort of 57-year-old patients with newly diagnosed CSDME.

METHODS

By using a Markov model with a 25-year time horizon, we compared the incremental cost-effectiveness of treating patients with newly diagnosed CSDME using L, L+R, L+B, or L+T. Data came from the DRCRnet randomized controlled trial, the Medicare fee schedule, and the medical literature.

MAIN OUTCOME MEASURES

Costs, quality-adjusted life years (QALYs), and incremental costs per QALY gained.

RESULTS

Compared with L, the incremental cost-effectiveness of L+R and L+B was $89903/QALY and $11138/QALY, respectively. L+T was dominated by L. A probabilistic sensitivity analysis demonstrated that, at a willingness to pay (WTP) of $50000/QALY, L was approximately 70% likely to be the preferred therapy over L+R and L+T. However, at a WTP of $100000/QALY, more than 90% of the time, L+R therapy was the preferred therapy compared with L and L+T. In the probabilistic sensitivity analysis, L+B was found to be the preferred therapy over L and L+T for any WTP value >$10000/QALY. Sensitivity analyses revealed that the annual risk of cerebrovascular accident would have to be at least 1.5% higher with L+B than with L+R for L+R to be the preferred treatment. In another sensitivity analysis, if patients require <8 injections per year over the remainder of the 25-year time horizon, L+B would cost <$100000/QALY, whereas L+R would be cost-effective at a WTP of $100000/QALY if patients require fewer than 0.45 injections per year after year 2.

CONCLUSIONS

With bevacizumab and ranibizumab assumed to have equivalent effectiveness and similar safety profiles when used in the management of CSDME, bevacizumab therapy confers the greatest value among the different treatment options for CSDME.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 48105, USA. jdstein@med.umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23642372

Citation

Stein, Joshua D., et al. "Cost-effectiveness of Various Interventions for Newly Diagnosed Diabetic Macular Edema." Ophthalmology, vol. 120, no. 9, 2013, pp. 1835-42.
Stein JD, Newman-Casey PA, Kim DD, et al. Cost-effectiveness of various interventions for newly diagnosed diabetic macular edema. Ophthalmology. 2013;120(9):1835-42.
Stein, J. D., Newman-Casey, P. A., Kim, D. D., Nwanyanwu, K. H., Johnson, M. W., & Hutton, D. W. (2013). Cost-effectiveness of various interventions for newly diagnosed diabetic macular edema. Ophthalmology, 120(9), 1835-42. https://doi.org/10.1016/j.ophtha.2013.02.002
Stein JD, et al. Cost-effectiveness of Various Interventions for Newly Diagnosed Diabetic Macular Edema. Ophthalmology. 2013;120(9):1835-42. PubMed PMID: 23642372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of various interventions for newly diagnosed diabetic macular edema. AU - Stein,Joshua D, AU - Newman-Casey,Paula Anne, AU - Kim,David D, AU - Nwanyanwu,Kristen Harris, AU - Johnson,Mark W, AU - Hutton,David W, Y1 - 2013/05/01/ PY - 2012/08/09/received PY - 2013/02/01/revised PY - 2013/02/05/accepted PY - 2013/5/7/entrez PY - 2013/5/7/pubmed PY - 2013/11/20/medline SP - 1835 EP - 42 JF - Ophthalmology JO - Ophthalmology VL - 120 IS - 9 N2 - OBJECTIVE: Anti-vascular endothelial growth factor therapies have revolutionized the treatment of clinically significant diabetic macular edema (CSDME); yet these agents are expensive, and whether they are cost-effective is unclear. The purpose of this study is to determine the most cost-effective treatment option for patients with newly diagnosed CSDME: focal laser photocoagulation alone (L), focal laser plus intravitreal ranibizumab (L+R), focal laser plus intravitreal bevacizumab (L+B), or focal laser plus intravitreal triamcinolone (L+T) injections. DESIGN: Cost-effectiveness analysis. PARTICIPANTS: Hypothetical cohort of 57-year-old patients with newly diagnosed CSDME. METHODS: By using a Markov model with a 25-year time horizon, we compared the incremental cost-effectiveness of treating patients with newly diagnosed CSDME using L, L+R, L+B, or L+T. Data came from the DRCRnet randomized controlled trial, the Medicare fee schedule, and the medical literature. MAIN OUTCOME MEASURES: Costs, quality-adjusted life years (QALYs), and incremental costs per QALY gained. RESULTS: Compared with L, the incremental cost-effectiveness of L+R and L+B was $89903/QALY and $11138/QALY, respectively. L+T was dominated by L. A probabilistic sensitivity analysis demonstrated that, at a willingness to pay (WTP) of $50000/QALY, L was approximately 70% likely to be the preferred therapy over L+R and L+T. However, at a WTP of $100000/QALY, more than 90% of the time, L+R therapy was the preferred therapy compared with L and L+T. In the probabilistic sensitivity analysis, L+B was found to be the preferred therapy over L and L+T for any WTP value >$10000/QALY. Sensitivity analyses revealed that the annual risk of cerebrovascular accident would have to be at least 1.5% higher with L+B than with L+R for L+R to be the preferred treatment. In another sensitivity analysis, if patients require <8 injections per year over the remainder of the 25-year time horizon, L+B would cost <$100000/QALY, whereas L+R would be cost-effective at a WTP of $100000/QALY if patients require fewer than 0.45 injections per year after year 2. CONCLUSIONS: With bevacizumab and ranibizumab assumed to have equivalent effectiveness and similar safety profiles when used in the management of CSDME, bevacizumab therapy confers the greatest value among the different treatment options for CSDME. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/23642372/Cost_effectiveness_of_various_interventions_for_newly_diagnosed_diabetic_macular_edema_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(13)00121-8 DB - PRIME DP - Unbound Medicine ER -