Economic considerations of macular edema therapies

Purpose To relate costs and treatment benefits for diabetic macular edema (DME), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO). Design A model of resource use, outcomes, and cost-effectiveness and utility. Participants None. Methods Results from published clinical trials (index studies) of laser, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents, and vitrectomy trials were used to ascertain visual benefit and clinical protocols. Calculations followed from the costs of 1 year of treatment for each treatment modality and the visual benefits as ascertained. Main Outcome Measures Visual acuity (VA) saved, cost of therapy, cost per line saved, cost per line-year saved, and costs per quality-adjusted life years (QALYs). Results The lines saved for DME (0.262.02), BRVO (0.744.92), and CRVO (1.23.75) yielded calculations of costs/line of saved VA for DME ($1329$11,609), BRVO ($494$13,039), and CRVO ($704$7611); costs/line-year for DME ($60$561), BRVO ($25$754), and CRVO ($45$473); and costs/QALY ($824 to $25,566). Conclusions Relative costs and benefits should be considered in perspective when applying and developing treatment strategies. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.