Economic considerations of macular edema therapies

Abstract

Purpose: To relate costs and treatment benefits for diabetic macular edema (DME), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO).

Design: A model of resource use, outcomes, and cost-effectiveness and utility.

Participants: None.

Methods: Results from published clinical trials (index studies) of laser, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents, and vitrectomy trials were used to ascertain visual benefit and clinical protocols. Calculations followed from the costs of 1 year of treatment for each treatment modality and the visual benefits as ascertained.

Main outcome measures: Visual acuity (VA) saved, cost of therapy, cost per line saved, cost per line-year saved, and costs per quality-adjusted life years (QALYs).

Results: The lines saved for DME (0.26-2.02), BRVO (0.74-4.92), and CRVO (1.2-3.75) yielded calculations of costs/line of saved VA for DME ($1329-$11,609), BRVO ($494-$13,039), and CRVO ($704-$7611); costs/line-year for DME ($60-$561), BRVO ($25-$754), and CRVO ($45-$473); and costs/QALY ($824 to $25,566).

Conclusions: Relative costs and benefits should be considered in perspective when applying and developing treatment strategies.

Figure 1

Graph showing mean proportional costs of professional fees (pro), technical (tech), and, drug costs for the options of diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion. The two sets of columns of data for bevacizumab results are from the Pan American Collaborative Retina Study (PACORES) and Bevacizumab or Laser Therapy in the Management of Diabetic Macular Edema Study, Report #2 (BOLT-2), and the ranibizumab data are from the Diabetic Retinopathy Clinical Research (DRCR) study and Ranibizumab of Edema of the Macular in Diabetes Study, Report #2 (READ-2). Vitrectomy data is for treatment of diabetic macular edema only. (IVTA= intravitreal triamcinolone acetonide)