Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6.

Rob W P Simons, Laura H P Wielders, Rudy M M A Nuijts, Claudette A Veldhuizen, Frank J H M van den Biggelaar, Bjorn Winkens, Jan S A G Schouten, Carmen D Dirksen, ESCRS PREMED Study Group

Journal of cataract and refractive surgery 2022 May 01

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To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema after cataract surgery in diabetic patients. 7 ophthalmology clinics in the Netherlands and Belgium. Prospective trial-based cost-effectiveness analysis using data from a European multicenter randomized clinical trial. Diabetic patients (n = 163) undergoing uneventful cataract surgery were randomized to perioperative subconjunctival triamcinolone acetonide (n = 36), perioperative intravitreal bevacizumab (n = 36), combination treatment (n = 45), or no additional treatment (control group, n = 46). The cost analysis was performed from a healthcare perspective within a 12-week postoperative time horizon. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER; cost per QALY). The mean total healthcare costs and QALYs were as follows: triamcinolone group €1827 (U.S. dollars [$] 2295)/0.166; bevacizumab group €2050 ($2575)/0.144; combination group €2027 ($2546)/0.166; and control group €2041 ($2564)/0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was €321 984 ($404 503) per QALY for the combination group compared with that of the triamcinolone group. Assuming the willingness-to-pay as €20 000 ($25 126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient who received triamcinolone developed clinically significant macular edema (CSME). A secondary cost-effectiveness analysis based on this outcome showed a clear preference for triamcinolone. In diabetic patients, subconjunctival triamcinolone was effective in preventing CSME after cataract surgery. The cost-effectiveness analysis showed that triamcinolone is also cost-effective. Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.

Citation

Rob W P Simons, Laura H P Wielders, Rudy M M A Nuijts, Claudette A Veldhuizen, Frank J H M van den Biggelaar, Bjorn Winkens, Jan S A G Schouten, Carmen D Dirksen, ESCRS PREMED Study Group. Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6. Journal of cataract and refractive surgery. 2022 May 01;48(5):555-563