Tags

Type your tag names separated by a space and hit enter

Cost-effectiveness of treatment of diabetic macular edema.
Ann Intern Med. 2014 Jan 07; 160(1):18-29.AIM

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).

DESIGN

Markov model.

DATA SOURCES

Published literature and expert opinion.

TARGET POPULATION

Patients with clinically significant DME.

TIME HORIZON

Lifetime.

PERSPECTIVE

Societal.

INTERVENTION

Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both.

OUTCOME MEASURES

Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).

RESULTS OF BASE-CASE ANALYSIS

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 OF SENSITIVITY ANALYSIS

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.

LIMITATION

Long-term outcome data for treated and untreated diseases are limited.

CONCLUSION

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.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

Authors

No affiliation info availableNo 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, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

24573663

Citation

Pershing, Suzann, et al. "Cost-effectiveness of Treatment of Diabetic Macular Edema." Annals of Internal Medicine, vol. 160, no. 1, 2014, pp. 18-29.
Pershing S, Enns EA, Matesic B, et al. Cost-effectiveness of treatment of diabetic macular edema. Ann Intern Med. 2014;160(1):18-29.
Pershing, S., Enns, E. A., Matesic, B., Owens, D. K., & Goldhaber-Fiebert, J. D. (2014). Cost-effectiveness of treatment of diabetic macular edema. Annals of Internal Medicine, 160(1), 18-29. https://doi.org/10.7326/M13-0768
Pershing S, et al. Cost-effectiveness of Treatment of Diabetic Macular Edema. Ann Intern Med. 2014 Jan 7;160(1):18-29. PubMed PMID: 24573663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of treatment of diabetic macular edema. AU - Pershing,Suzann, AU - Enns,Eva A, AU - Matesic,Brian, AU - Owens,Douglas K, AU - Goldhaber-Fiebert,Jeremy D, PY - 2014/2/28/entrez PY - 2014/2/28/pubmed PY - 2014/4/1/medline SP - 18 EP - 29 JF - Annals of internal medicine JO - Ann Intern Med VL - 160 IS - 1 N2 - 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). DESIGN: Markov model. DATA SOURCES: Published literature and expert opinion. TARGET POPULATION: Patients with clinically significant DME. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both. OUTCOME MEASURES: Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: 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 OF SENSITIVITY ANALYSIS: 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. LIMITATION: Long-term outcome data for treated and untreated diseases are limited. CONCLUSION: 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. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/24573663/Cost_effectiveness_of_treatment_of_diabetic_macular_edema_ L2 - https://www.acpjournals.org/doi/10.7326/M13-0768?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -