Hodgson Robert, Walton Matthew, Fulbright Helen, Bojke Laura, Walker Ruth, Llewellyn Alexis, Dias Sofia, Stewart Lesley, Steel David, Lawrenson John, Peto Tunde, Simmonds Mark
Centre for Reviews and Dissemination, University of York, York, UK.
Centre for Health Economics, University of York, York, UK.
Health Technol Assess. 2025 Jan 29:1-19. doi: 10.3310/NHYK3694.
Non-proliferative and proliferative diabetic retinopathy are common complications of diabetes and a major cause of sight loss. Anti-vascular endothelial growth factor drugs represent a treatment option for people with diabetic retinopathy and are routinely used to treat various other eye conditions. However, anti-vascular endothelial growth factor drugs are expensive relative to current care options, and it is unclear whether this additional cost is justified when the immediate risk of vision loss is lower compared to patients with more aggressive ophthalmological conditions.
To systematically review the evidence supporting the cost-effectiveness of alternative treatments for diabetic retinopathy.
A systematic review of all comparative cost-effectiveness studies evaluating any treatment for diabetic retinopathy was conducted. Bibliographic searches were carried out to identify studies reporting on the cost-effectiveness of treatments for diabetic retinopathy; the latest searches were conducted on 28 April 2023. Included studies were synthesised narratively and evaluated with reference to UK decision-making. Studies were grouped by population into non-proliferative diabetic retinopathy and proliferative diabetic retinopathy.
The review identified five studies in the proliferative diabetic retinopathy population, all of which examined the cost-effectiveness of anti-vascular endothelial growth factor treatments compared to pan-retinal photocoagulation. Results of these studies suggest that anti-vascular endothelial growth factor treatments offer some additional benefits in terms of preserved visual acuity but also incur substantial additional costs relative to pan-retinal photocoagulation. Most authors agreed that the additional costs outweigh the limited benefits, especially in certain patient subgroups without pre-existing oedema. As most of the identified evidence considered a US perspective, it is unclear how these results would translate to a UK setting. Two studies were identified in the non-proliferative diabetic retinopathy population. There was limited evidence to support the early use of anti-vascular endothelial growth factor treatment. However, one UK study suggested that early treatment of non-proliferative diabetic retinopathy with pan-retinal photocoagulation is cost-effective compared to delayed pan-retinal photocoagulation.
Overall, there is a dearth of cost-effectiveness evidence considering the UK context. The identified studies raised doubts about the cost-effectiveness of anti-vascular endothelial growth factor treatments for proliferative diabetic retinopathy. No conclusions can be made regarding the cost-effectiveness of anti-vascular endothelial growth factor treatments for non-proliferative diabetic retinopathy. Future research should focus on developing rigorous model-based cost-effectiveness analyses integrating all available evidence.
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR132948.
非增殖性和增殖性糖尿病视网膜病变是糖尿病常见的并发症，也是视力丧失的主要原因。抗血管内皮生长因子药物是糖尿病视网膜病变患者的一种治疗选择，常用于治疗各种其他眼部疾病。然而，与目前的治疗方案相比，抗血管内皮生长因子药物价格昂贵，而且当与眼部疾病更严重的患者相比，视力丧失的直接风险较低时，这种额外的成本是否合理尚不清楚。
系统评价支持糖尿病视网膜病变替代治疗成本效益的证据。
对所有评估糖尿病视网膜病变任何治疗方法的比较成本效益研究进行系统评价。进行文献检索以确定报告糖尿病视网膜病变治疗成本效益的研究；最近一次检索于2023年4月28日进行。纳入的研究进行叙述性综合，并参照英国的决策进行评估。研究按人群分为非增殖性糖尿病视网膜病变和增殖性糖尿病视网膜病变。
该评价在增殖性糖尿病视网膜病变人群中确定了五项研究，所有这些研究都考察了抗血管内皮生长因子治疗与全视网膜光凝相比的成本效益。这些研究结果表明，抗血管内皮生长因子治疗在保留视力方面有一些额外的益处，但相对于全视网膜光凝也会产生大量额外成本。大多数作者一致认为，额外成本超过了有限的益处，特别是在某些无既往水肿的患者亚组中。由于大多数已确定的证据是从美国的角度考虑的，尚不清楚这些结果如何转化为英国的情况。在非增殖性糖尿病视网膜病变人群中确定了两项研究。支持早期使用抗血管内皮生长因子治疗的证据有限。然而，一项英国研究表明，与延迟进行全视网膜光凝相比，早期对非增殖性糖尿病视网膜病变进行全视网膜光凝治疗具有成本效益。
总体而言，考虑到英国的情况，缺乏成本效益证据。已确定的研究对增殖性糖尿病视网膜病变抗血管内皮生长因子治疗的成本效益提出了质疑。对于非增殖性糖尿病视网膜病变抗血管内皮生长因子治疗的成本效益无法得出结论。未来的研究应侧重于开展基于严格模型的成本效益分析，整合所有可用证据。
本文介绍了由国家卫生与保健研究所（NIHR）卫生技术评估计划资助的独立研究，资助编号为NIHR132948。
