Resultados coste-efectividad del implante de dexametasona en edema macular

López, Vicente Navarro; García, M. Serrano; Sarmiento, C. Mantolán; Ríos, Alicia; Castillo, M. J. Losada; Dorta, L. Cordovés; Fumero, E. Quijada; Aller, T. Virgós; Molina, M Bullejos

doi:10.1016/j.oftal.2013.10.007

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Despite the clinical, social, and economic relevance of this therapy area, data evaluating the cost effectiveness of DEX-i in DME are limited [ 21 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

Ruiz-Moreno

Ruiz‐Medrano

2022

Graefes Arch Clin Exp Ophthalmol

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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). 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. 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. 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.

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“…Despite the clinical, social, and economic relevance of this therapy area, data evaluating the cost effectiveness of DEX-i in DME are limited [ 21 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

Ruiz-Moreno

Ruiz‐Medrano

2022

Graefes Arch Clin Exp Ophthalmol

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“…However, the approval studies for VEGF inhibitors [25–27] to treat ME due to RVO showed a higher ETDRS letter gain than the GENEVA trial [7, 8]. A combination therapy may lead to higher VA gain despite fewer necessary injections than with VEGF inhibitor therapy alone [28–31] and may be therefore cost-effective [32]. Despite this a combination therapy would not resolve the macular and retinal ischemia which was associated to limited final VA in our study.…”

Section: Discussionmentioning

confidence: 99%

Retrospective, controlled observational case study of patients with central retinal vein occlusion and initially low visual acuity treated with an intravitreal dexamethasone implant

et al. 2016

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BackgroundPatients with initially low visual acuity were excluded from the therapy approval studies for retinal vein occlusion. But up to 28 % of patients presenting with central retinal vein occlusion have a baseline BCVA of less than 34 ETDRS letters (0.1). The purpose of our study was to assess visual acuity and central retinal thickness in patients suffering from central retinal vein occlusion and low visual acuity (<0.1) in comparison to patients with visual acuity (≥0.1) treated with Dexamethasone implant 0.7 mg for macular edema.MethodsRetrospective, controlled observational case study of 30 eyes with macular edema secondary to central retinal vein occlusion, which were treated with a dexamethasone implantation. Visual acuity, central retinal thickness and intraocular pressure were measured monthly. Analyses were performed separately for eyes with visual acuity <0.1 and ≥0.1.ResultsTwo months post intervention, visual acuity improved only marginally from 0.05 to 0.07 (1 month; p = 0,065) and to 0.08 (2 months; p = 0,2) in patients with low visual acuity as compared to patients with visual acuity ≥0.1 with an improvement from 0.33 to 0.47 (1 month; p = 0,005) and to 0.49 (2 months; p = 0,003). The central retinal thickness, however, was reduced in both groups, falling from 694 to 344 μm (1 month; p = 0.003,) to 361 μm (2 months; p = 0,002) and to 415 μm (3 months; p = 0,004) in the low visual acuity group and from 634 to 315 μm (1 month; p < 0,001) and to 343 μm (2 months; p = 0,001) in the visual acuity group ≥0.1. Absence of visual acuity improvement was related to macular ischemia.ConclusionsIn patients with central retinal vein occlusion and initially low visual acuity, a dexamethasone implantation can lead to an important reduction of central retinal thickness but may be of limited use to increase visual acuity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-016-0363-5) contains supplementary material, which is available to authorized users.

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“…Despite the clinical, social and economic relevance of this therapeutic area, data evaluating the cost effectiveness of DEX-i in DME are limited [ 22 , 23 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Dexamethasone Intravitreal Implant in Naïve and Previously Treated Patients with Diabetic Macular Edema

Medina-Baena

Cejudo-Corbalán

Labella-Quesada

et al. 2023

IJERPH

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Purpose: To compare the direct costs associated with the dexamethasone intravitreal implant (DEX-i) in treatment-naïve and previously treated eyes with diabetic macular edema (DME) in a real clinical setting. Methods: Retrospective and single-center study conducted in a real clinical scenario. Consecutive DME patients, either naïve or previously treated with vascular endothelial growth factor inhibitors (anti-VEGF), who received treatment with one or more DEX-i between May 2015 and December 2020, and who were followed-up for a minimum of 12 months, were included in the study. The cost analysis was performed from the perspective of the Andalusian Regional Healthcare Service. The primary effectiveness endpoint was the probability of achieving an improvement in best-corrected visual acuity (BCVA) ≥ 15 ETDRS letters after 1 year of treatment. The incremental cost-effectiveness ratio (ICER) of different improvements in BCVA was calculated. Results: Forty-nine eyes, twenty-eight (57.1%) eyes from the treatment-naïve group and twenty-one (42.9%) from the previously treated group, were included in the analysis. The total cost of one year of treatment was significantly lower in the treatment-naïve eyes than in the previously treated eyes [Hodges-Lehmann median difference: EUR 819.1; 95% confidence interval (CI): EUR 786.9 to EUR 1572.8; p < 0.0001]. The probability of achieving a BCVA improvement of ≥15 letters at month 12 was significantly greater in the treatment-naïve group than in the previously treated group (rate difference: 0.321; 95% CI: 0.066 to 0.709; p = 0.0272). The Cochran–Mantel–Haenszel Odds Ratio of achieving a BCVA improvement of ≥15 letters at month 12 was 3.55 (95% CI: 1.09 to 11.58; p = 0.0309). In terms of ICER, the treatment-naïve group showed cost savings of EUR 7704.2 and EUR 5994.2 for achieving an improvement in BCVA ≥ 15 letters at month 12 and at any of the measured time points, respectively. Conclusions: DEX-i was found to be more cost-effective in treatment-naïve eyes than in those previously treated with anti-VEGF. Further studies are needed to determine the most cost-effective treatment based on patient profile.

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Resultados coste-efectividad del implante de dexametasona en edema macular

Cited by 7 publications

References 14 publications

Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

Retrospective, controlled observational case study of patients with central retinal vein occlusion and initially low visual acuity treated with an intravitreal dexamethasone implant

Cost-Effectiveness of Dexamethasone Intravitreal Implant in Naïve and Previously Treated Patients with Diabetic Macular Edema

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