Economic evaluation of pharmacological strategies to prevent cystoid macular edema after cataract surgery in diabetic patients: results from the ESCRS PREMED study

Session Details

Session Title: Cataract Surgery & Retinal Complications

Session Date/Time: Tuesday 25/09/2018 | 16:30-18:00

Paper Time: 16:36

Venue: Room A3, Podium 1

First Author: : R.Simons THE NETHERLANDS

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

Abstract Details

Purpose:

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

Setting:

This study uses a subset of 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 The Netherlands and Belgium.

Methods:

144 eyes of 144 diabetic patients undergoing cataract surgery were included in the economic evaluation. All patients were treated with topical bromfenac and dexamethasone. Patients were randomized to receive: 1) perioperative subconjunctival injection of 40mg triamcinolone acetonide, 2) perioperative intravitreal injection of 1.25mg bevacizumab, 3) both injections, 4) control group (no additional treatment). Quality-adjusted life years (QALYs) were measured with the Health Utilities Index Mark-3. All relevant costs from a healthcare perspective were included. Follow-up was twelve weeks postoperatively. The primary outcome was the net monetary benefit (NMB). Uncertainty analyses were performed to determine cost-effectiveness probabilities for each treatment.

Results:

Total costs were €1810, €2043, €2018, and €2068 in the triamcinolone acetonide, bevacizumab, combination, and control group, respectively. QALYs were 0.17, 0.14, 0.16, and 0.16, respectively. Assuming decision-makers are willing to pay €20,000 per QALY (the standard rate in the The Netherlands for conditions with limited burden of disease), the NMB was €1515 (76% probability that intervention is cost-effective compared to other treatments) in the triamcinolone acetonide group, €666 (0%) in the bevacizumab group, €1226 (15%) in the combination group, and €1099 (9%) in the control group.

Conclusions:

Costs were lowest in the triamcinolone acetonide group (€208 to €258 less) while QALYs were highest in that group. As a result, the cost-effectiveness analysis favored this treatment with a 76% probability of being cost-effective at a willingness-to-pay of €20.000 per QALY.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented