Healthcare resource use and costs of diabetic macular oedema for patients with antivascular endothelial growth factor versus a dexamethasone intravitreal implant in Korea: a population-based study

Abstract

ObjectivesTo estimate the costs and healthcare resources of patients with diabetic macular oedema (DME) who received intravitreal antivascular endothelial growth factor (anti-VEGF) agents or a dexamethasone intravitreal implant (DEX-implant) in Korea.DesignRetrospective cohort study.SettingThe Korean National Health Insurance claim data from 1 January 2015 to 30 June 2017 were retrieved from the Health Insurance Review and Assessment Service.ParticipantsAdult patients with DME who were diagnosed with diabetic retinopathy or DME and received ranibizumab, aflibercept or a DEX-implant in conjunction with intravitreal injection were included. Patients whose primary diagnoses were age-related macular degeneration or retinal vein occlusion were excluded.Main outcome measuresHealthcare resource utilisation and costs related to DME in the 12-month postindex period.ResultsDuring the study period, 182 patients and 414 patients were identified in the anti-VEGF and DEX-implant groups, respectively, and there was no significant difference in the demographic characteristics between the two groups. The outpatient eye care-related medical costs were US$3002.33 for the anti-VEGF group vs US$2250.35 for the DEX-implant group (p<0.0001). After adjusting the relevant covariates based on the generalised linear model, the estimated outpatient eye care-related medical costs were 33% higher in the anti-VEGF group than in the DEX-implant group (p<0.0001, 95% CI 22% to 45%). The utilisation pattern of the two groups showed no significant difference except for the number of intravitreal injections, which was higher in the anti-VEGF group (2.69±2.29) than in the DEX-implant group (2.09±1.37, p<0.001).ConclusionThe average annual eye-related medical cost of the DEX-implant group was significantly lower than that of the anti-VEGF group during the study period, which was mainly due to decreased utilisation of eye care-related injections. Further long-term studies are needed.

Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study)

“…This finding corroborates the results of a previous Korean study conducted in a DME population comprising incident as well as prevalent cases, which showed a 33% lower treatment cost for DXI compared to RAN and AFL over a 12-month period. 13 The frequency of injection of anti-VEGF agents in this study is lower than the currently recommended frequency of injection as per the treat-and-extend (T&E) protocol, 14,15 which aims to maintain patients' visual acuity in the long term while reducing the number of follow-up visits, procedures and injections. This is explained by the fact that the INVICTUS study was conducted in 2016-2017, before the implementation of the T&E protocol.…”

Intravitreal ranibizumab and dexamethasone implant injections as primary treatment of diabetic macular edema: simultaneously double protocol

“…A cost-effectiveness analysis accompanying the 1-year data of Protocol T revealed that aflibercept was not cost-effective versus ranibizumab for all patients using a model with a 1-year time horizon, but was cost-effective in patients with baseline VA of 20/50 or worse using a 10-year time horizon [ 25 ]. Real-world healthcare utilization of DMO cohorts who were treated with anti-VEGF or the DEX implant and using data from the Korean NHI claim database study was showed that the average annual eye-related medical cost of the DEX implant group was significantly lower than that of the anti-VEGF group during the study period, which was mainly due to decreased utilization of eye care-related injections [ 26 ]. Although both treatment arms have similar costs in our study, simultaneous DEX implant and ranibizumab treatment are more effective for improving vision in patients with DMO during long-term follow-up (12 months), suggesting that the DEX implant might be clinically beneficial as well as economically attractive.…”

Diabetic Retinopathy and Related Clinical Practice for People with Diabetes in Korea: A 10-Year Trend Analysis

“…Bevacizumab is a globally used anti-VEGF agent for diabetic macular edema or complications of PDR [ 5 ]; however, intravitreal bevacizumab injections were not identified in this analysis, as this procedure is not covered by NHIS because of its off-label use in Korea. Moreover, the use of ranibizumab and aflibercept were not identified in this study, as they have been covered by NHIS since 2015 [ 20 ]. The effect of anti-VEGF agents in DR progression needs to be evaluated in further studies.…”