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Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study.
- Source :
-
Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie [Graefes Arch Clin Exp Ophthalmol] 2023 Apr; Vol. 261 (4), pp. 941-949. Date of Electronic Publication: 2022 Nov 12. - Publication Year :
- 2023
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Abstract
- Background: To evaluate the cost-effectiveness of early- versus late-switch to the intravitreal-dexamethasone implant (DEX-i) in patients with diabetic macular edema (DME) who did not adequately respond to vascular endothelial growth factor inhibitors (anti-VEGF).<br />Methods: Retrospective analysis of a multicenter Clinical Data Registry. The registry included DME eyes who received 3 intravitreal anti-VEGF injections (early-switch) or > 3 intravitreal anti-VEGF injections (late-switch) before switching to DEX-i injections. The primary outcome was to estimate the incremental cost needed to obtain a best-corrected visual acuity (BCVA) improvement ≥ 0.1 or a central-retinal thickness CRT ≤ 250 μm.<br />Results: The analysis included 108 eyes, 32 (29.6%) and 76 (70.4%) in the early- and late-switch groups, respectively. Early-switch strategy was associated with a cost saving of €3,057.8; 95% CI: €2,406.4-3,928.4, p < 0.0001). Regarding incremental-cost-effectiveness ratio, late-switch group was associated with an incremental cost of €25,735.2 and €13,533.2 for achieving a BCVA improvement ≥ 0.1 at month 12 and at any of the time-point measured, respectively. At month 12, 38 (35.2%) eyes achieved a BCVA improvement ≥ 0.1. At month 12, 52 (48.1) eyes had achieved a CRT ≤ 250 micron. As compared to baseline, the mean (95% CI) CRT reduction was - 163.1 (- 212.5 to - 113.7) µm and - 161.6 (- 183.8 to - 139.3) µm in the early-switch and late-switch groups, respectively, p = 0.9463.<br />Conclusions: In DME eyes, who did not adequately respond to anti-VEGF, switching to DEX-i at early stages (after the first 3-monthly injections) was found to be more cost-effective than extending the treatment to 6-monthly injections of anti-VEGF.<br /> (© 2022. The Author(s).)
- Subjects :
- Humans
Glucocorticoids
Dexamethasone
Cost-Benefit Analysis
Vascular Endothelial Growth Factor A
Retrospective Studies
Drug Implants therapeutic use
Intravitreal Injections
Retina
Macular Edema diagnosis
Macular Edema drug therapy
Macular Edema etiology
Diabetic Retinopathy complications
Diabetic Retinopathy diagnosis
Diabetic Retinopathy drug therapy
Diabetes Mellitus drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1435-702X
- Volume :
- 261
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
- Publication Type :
- Academic Journal
- Accession number :
- 36370170
- Full Text :
- https://doi.org/10.1007/s00417-022-05892-3