Economic evaluation of pharmaceutical strategies to prevent cystoid macular edema after cataract surgery in nondiabetic and diabetic patients

Session Details

Session Title: Cataract Surgery Paediatric/Complications/Management

Session Date/Time: Monday 09/10/2017 | 16:30-18:00

Paper Time: 17:29

Venue: Room 4.1

First Author: : R.Simons THE NETHERLANDS

Co Author(s): :    L. Wielders   J. Schouten   F. van den Biggelaar   B. Winkens   C. Veldhuizen   R. Nuijts     

Abstract Details

Purpose:

To evaluate the cost-effectiveness of various pharmaceutical strategies in preventing cystoid macular edema (CME) after cataract surgery in nondiabetic and diabetic patients.

Setting:

This study uses a subset of the data from the European Society of Cataract and Refractive Surgeons (ESCRS) PREvention of Macular EDema after cataract surgery (PREMED) study, a multinational multicenter randomized clinical trial. Data for the economic evaluation were collected in seven ophthalmology clinics in the Netherlands and Belgium.

Methods:

A total of 760 nondiabetic patients undergoing cataract surgery were randomized to postoperative treatment (starting two days preoperatively) with topical bromfenac, topical dexamethasone, or a combination of both. Diabetic patients received both eye drops and were randomized (n=185) to receive no extra medication (control), intraoperative subconjunctival triamcinolone acetonide, intraoperative intravitreal bevacizumab, or a combination of both. Quality-adjusted life years (QALYs) and vision-related quality of life (VRQL) were measured with the Health Utilities Index Mark-3 and the Visual Functioning Questionnaire-25, respectively. The power of the study was based on OCT-measured central subfield macular thickness. Follow-up duration was twelve weeks postoperatively.

Results:

Preliminary analyses showed that average QALYs were not statistically significantly different in the nondiabetic treatments groups or in the diabetic treatment groups. There were also no statistically significant differences between treatment groups in VRQL improvement. Costs of medication were €7.31 (bromfenac), €2.50 (dexamethasone), and €9.81 (combination) in the nondiabetic treatment groups. In the diabetic population costs were €9.81 (control), €74.81 (triamcinolone acetonide), €59.81 (bevacizumab), and €124.81 (combination).

Conclusions:

Based on a preliminary analysis of the data from the ESCRS PREMED study, there were no statistically significant differences in QALYs or VRQL improvement twelve weeks after cataract surgery. Based on the costs of medication only, topical dexamethasone was the least expensive preventive strategy in nondiabetic patients and topical treatment with a combination of dexamethasone and bromfenac (control group) was the least expensive strategy in the diabetic population. A more comprehensive cost-effectiveness analysis will be performed that will evaluate the impact of other types of outcomes and costs (e.g., complications, outpatient visits) on cost-effectiveness.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented