Publisher Full Text
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.
Links
MeSH
Administration, OphthalmicAnti-Inflammatory AgentsAntibodies, Monoclonal, HumanizedBevacizumabCombined Modality TherapyCost-Benefit AnalysisDiabetic RetinopathyDisease ProgressionFemaleHumansLaser TherapyMacular EdemaMaleMarkov ChainsMiddle AgedQuality-Adjusted Life YearsReceptors, Vascular Endothelial Growth FactorRecombinant Fusion ProteinsTreatment OutcomeTriamcinoloneVascular Endothelial Growth Factor AVisual Acuity
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 -
Latest evidence on COVID-19 from PubMed, WHO, CDC.
Visit free Relief Central.
Visit free Relief Central.
Try the Free App:
