Cost Evaluation of Early Vitrectomy versus Panretinal Photocoagulation and Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy

Lin, James; Chang, Jonathan S.; Yannuzzi, Nicolas A.; Smiddy, William E.

doi:10.1016/j.ophtha.2018.02.038

Cited by 41 publications

(46 citation statements)

References 45 publications

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“…Smiddy64 concluded that the relative cost and benefits of anti-VEGF therapy should also be considered when considering the treatment strategies. Vitrectomy was reported to be a useful method in terms of the relative costs and benefits for diabetic macular edema64 and proliferative diabetic retinopathy 65. We believe that vitrectomy is a useful therapy for macular edema due to RVO in terms of the relative costs and benefits.…”

Section: Discussionmentioning

confidence: 85%

<p>Vitrectomy for macular edema due to retinal vein occlusion</p>

Kumagai

Ogino²,

Fukami

et al. 2019

OPTH

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Purpose: To determine the long-term outcomes of vitrectomy for the macular edema associated with a retinal vein occlusion (RVO). Methods: This was a retrospective, consecutive, interventional case series. The intraoperative procedures included internal limiting membrane peeling, arteriovenous sheathotomy, radial optic neurotomy, and intravitreal triamcinolone acetonide injection at the end of the surgery. The main outcome was the best-corrected visual acuity (BCVA). Results: Eight hundred and fifty-four eyes of 854 patients were studied. The eyes consisted of 602 with branch RVO (BRVO), 74 with hemi-central RVO (hemi-CRVO), 87 with nonischemic central retinal vein occlusion (CRVO), and 91 with ischemic CRVO. The mean follow-up period was 68.6 months with a range of 12 to 262 months. The mean BCVA was significantly improved at the final visit ( P <0.0001 to 0.0016). The final BCVA improved in 74.4% of the BRVO eyes, in 58.1% of the hemi-CRVO eyes, in 57.4% of the nonischemic CRVO eyes, and in 51.6% of the ischemic CRVO eyes. Multiple regression analysis showed there was no significant relationship between the intraoperative combined procedures and the final BCVA. Conclusions: The results indicate that the type of RVO is significantly associated with the final BCVA, and vitrectomy is a treatment option to improve and maintain BCVA for a long term.

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Section: Discussionmentioning

confidence: 85%

<p>Vitrectomy for macular edema due to retinal vein occlusion</p>

Kumagai

Ogino²,

Fukami

et al. 2019

OPTH

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“…Patients with multiple diabetes comorbidity, low compliance, and treatment fatigue are also the obstacles to overcome (Ting and Wong, 2017). Lin et al (2018) conducted a decision analysis in order to assess cost and cost-utility of PRP and intravitreal ranibizumab (IVR) for PDR without DME. For 2 years of utility in facility setting, modeled cost per quality-adjusted life years of treatment was $163 988 in PRP group and $436 992 in IVR group.…”

Section: Discussionmentioning

confidence: 99%

Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials

2020

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Aim: To compare anti-vascular growth factor (anti-VEGF) pharmacotherapy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). Method: PubMed, Embase, Medline, the ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials were reviewed systemically. Randomized controlled trials (RCT) on anti-VEGF therapy versus PRP or anti-VEGF agent combined with PRP versus PRP for PDR are eligible to be included. Outcome measures were regression and recurrence of neovascularization, change in best corrected vision acuity, development of vitreous hemorrhage, and need for vitrectomy. A meta-analysis was conducted using RevMan (Cochrane Collaboration, Oxford, United Kingdom). Results: Twelve RCTs with a total of 1026 eyes were identified. The meta-analysis results showed that regression of neovascularization did not vary significantly among different treatment regimens (P=0.06), whereas the recurrence of new vessels was significantly lower in PRP monotherapy (P < 0.00001). The best corrected visual acuity was significantly improved with anti-VEGF monotherapy or in the combined group than in the PRP groups (P < 0.00001, P=0.04, respectively). Odds ratio for post-treatment vitreous hemorrhage and vitrectomy rate between anti-VEGF therapy and PRP were 0.65 (95% confidence interval, 0.45-0.95; P = 0.03), and 0.24 (95% confidence interval, 0.12-0.48; P < 0.0001). Conclusion: Our meta-analysis indicates that anti-VEGF pharmacotherapy is associated with superior visual acuity outcomes and less PDR-related complications. However, there is insufficient evidence to suggest anti-VEGF therapy as an alternative to PRP.

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“…Lin et al have evaluated the cost of PPV, PRP and IVR for the treatment of PDR,29 suggesting that early PPV for the treatment of PDR without DME demonstrates cost-utility-like PRP and more favourable cost utility compared with IVR assuming the need for IVR to be regular and continuous over a lifetime. In contrast to this, our study demonstrates only transient need for IVB for the treatment of VH with only 1.7 injections in average for each VH, and approximately 2 recurrences of VH over the 5-year period.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal bevacizumab improves the clearance of vitreous haemorrhage and visual outcomes in patients with proliferative diabetic retinopathy

2019

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ObjectiveTo evaluate the occurrence of vitreous haemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR) and the efficacy of intravitreal bevacizumab (IVB) for VH in 5-year real-life data.Methods and analysis850 adult patients with type 1 (T1D) or type 2 diabetes (T2D) with PDR were screened for VH. The effect of IVB was evaluated by the clearage of VH and the change in best corrected visual acuity (BCVA). The rates of VHs, reinjections, macular oedema, complications, additional treatments and outcomes of spontaneous resorption, panretinal photocoagulation or pars plana vitrectomy (PPV) for VH were also investigated.ResultsVH occurred in 16% of patients with T1D and 9% of patients with T2D with PDR. 336 VHs in 140 eyes of 103 patients were documented. VH was cleared in 92% of cases in less than 3 months by the initial IVB. IVB was superior to other treatment methods in shortening the time for clearance of VH (Kaplan-Meier, p<0.0001). The average rate of IVB reinjections was 1.7±1.1 and the reinjection interval was 7.2±3.9 weeks. BCVA increased 0.73±0.04 logarithm of the minimum angle of resolution units after IVB (generalised estimating equations, p=0.0004). In 5 years, the patients had 2.2±2.7 recurrence of VHs. A simultaneous 72% decrease in the rate of PPVs was documented (p<0.0001).ConclusionVH occurs mostly in patients with T1D. The therapeutic effect of IVB for VH was significant and led to improved clearance of VH and visual outcome. Moreover, IVB prevented persistent and recurrent VHs and decreased the need for costly PPV.

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Cost Evaluation of Early Vitrectomy versus Panretinal Photocoagulation and Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy

Abstract: Early PPV as a strategy for treatment of PDR without macular edema demonstrates cost-utility similar to management with PRP and more favorable cost-utility compared with IVR in the short term. This advantage over IVR continues when lifetime costs are factored.

Cited by 41 publications

References 45 publications

<p>Vitrectomy for macular edema due to retinal vein occlusion</p>

<p>Vitrectomy for macular edema due to retinal vein occlusion</p>

Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials

Intravitreal bevacizumab improves the clearance of vitreous haemorrhage and visual outcomes in patients with proliferative diabetic retinopathy

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