Patel Nimesh A, Yannuzzi Nicolas A, Lin James, Smiddy William E
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Retina. 2022 Mar;6(3):213-218. doi: 10.1016/j.oret.2021.09.005. Epub 2021 Sep 20.
To calculate costs required to prevent center-involved diabetic macular edema (CI-DME) or proliferative diabetic retinopathy (PDR), and to improve the diabetic retinopathy severity score (DRSS) with intravitreal anti-VEGF injections, as reported for aflibercept in 2 randomized control trials.
Cost-effectiveness analysis modeling based on published data.
None.
Results from PANORAMA and the Diabetic Retinopathy Clinical Research Network Protocol W were analyzed. Parameters collected included DRSS, risk reduction of PDR, risk reduction of CI-DME, and the number of treatments required. Costs were modeled based on 2020 Medicare reimbursement data practice settings of hospital-based facility and nonfacility.
Cost to prevent cases of PDR and CI-DME and to improve DRSS stage.
Over 2 years in Protocol W, the cost required to prevent 1 case of PDR was $83 000 ($72 400) in the facility (nonfacility) setting; in PANORAMA, the corresponding 2-year costs were $89 400 ($75 000) for the 2-mg aflibercept every 16 weeks (2Q16) arm, and $91 200 ($89 900) for the 2-mg aflibercept every 8 weeks as needed (2Q8PRN) arm. To prevent 1 case of CI-DME with vision loss in Protocol W, the cost was $154 000 ($133 000). For all CI-DME, with and without vision loss, in PANORAMA, the costs to prevent a case were $70 900 ($59 500) for the 2Q16 arm and $90 000 ($88 800) for the 2Q8PRN arm. In Protocol W, the overall accumulated total for cost/DRSS unit change at the 2-year point for facility (nonfacility) setting was $2700 ($2400)/DRSS. In the first year alone, it was $2100 ($1800)/DRSS and in the second year, it was $6100 ($5300)/DRSS.
There is a considerable cost associated with the prevention of PDR and CI-DME with intravitreal aflibercept injections. A price per unit of change in DRSS is a new parameter that might serve as a benchmark in future utility analyses that could be used to bring the perspective to cost-utility considerations.
如两项随机对照试验中阿柏西普的报告所示，计算预防与中心相关的糖尿病性黄斑水肿（CI-DME）或增殖性糖尿病视网膜病变（PDR）所需的成本，以及通过玻璃体内注射抗VEGF改善糖尿病视网膜病变严重程度评分（DRSS）。
基于已发表数据的成本效益分析模型。
无。
分析了PANORAMA试验和糖尿病视网膜病变临床研究网络方案W的结果。收集的参数包括DRSS、PDR风险降低、CI-DME风险降低以及所需治疗次数。成本基于2020年医疗保险报销数据，以医院设施和非设施的实际情况为模型。
预防PDR和CI-DME病例以及改善DRSS分期的成本。
在方案W的两年中，在设施（非设施）环境中预防1例PDR所需的成本为83000美元（72400美元）；在PANORAMA试验中，每16周注射2毫克阿柏西普（2Q16）组的相应两年成本为89400美元（75000美元），按需每8周注射2毫克阿柏西普（2Q8PRN）组为91200美元（89900美元）。在方案W中，预防1例有视力丧失的CI-DME的成本为154000美元（133000美元）。对于PANORAMA试验中所有有或无视力丧失的CI-DME，2Q16组预防1例的成本为70900美元（59500美元），2Q8PRN组为90000美元（88800美元）。在方案W中，设施（非设施）环境下两年时成本/DRSS单位变化的总体累计总和为2700美元（2400美元）/DRSS。仅在第一年，为2100美元（1800美元）/DRSS，在第二年，为6100美元（5300美元）/DRSS。
玻璃体内注射阿柏西普预防PDR和CI-DME存在相当高的成本。DRSS单位变化的成本是一个新参数，可能成为未来效用分析的基准，可用于将视角引入成本效用考量。
