Anti-Vascular Endothelial Growth Factor Drugs Compared With Panretinal Photocoagulation for the Treatment of Proliferative Diabetic Retinopathy: A Cost-Effectiveness Analysis.

Autor: Walton M; Centre for Reviews and Dissemination, University of York, UK. Electronic address: matthew.walton@york.ac.uk., Bojke L; Centre for Health Economics, University of York, UK., Simmonds M; Centre for Reviews and Dissemination, University of York, UK., Walker R; Centre for Reviews and Dissemination, University of York, UK., Llewellyn A; Centre for Reviews and Dissemination, University of York, UK., Fulbright H; Centre for Reviews and Dissemination, University of York, UK., Dias S; Centre for Reviews and Dissemination, University of York, UK., Stewart LA; Centre for Reviews and Dissemination, University of York, UK., Rush T; Patient representative., Steel DH; Biosciences Institute, Newcastle University, UK., Lawrenson JG; Department of Optometry and Visual Sciences, City, University of London, UK., Peto T; Centre for Public Health, Queen's University Belfast, UK., Hodgson R; Centre for Reviews and Dissemination, University of York, UK.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2024 Jul; Vol. 27 (7), pp. 907-917. Date of Electronic Publication: 2024 Mar 26.
DOI: 10.1016/j.jval.2024.03.007
Abstrakt: Objectives: This study aimed to evaluate the cost-effectiveness of anti-vascular endothelial growth factor drugs (anti-VEGFs) compared with panretinal photocoagulation (PRP) for treating proliferative diabetic retinopathy (PDR) in the United Kingdom.
Methods: A discrete event simulation model was developed, informed by individual participant data meta-analysis. The model captures treatment effects on best corrected visual acuity in both eyes, and the occurrence of diabetic macular edema and vitreous hemorrhage. The model also estimates the value of undertaking further research to resolve decision uncertainty.
Results: Anti-VEGFs are unlikely to generate clinically meaningful benefits over PRP. The model predicted anti-VEGFs be more costly and similarly effective as PRP, generating 0.029 fewer quality-adjusted life-years at an additional cost of £3688, with a net health benefit of -0.214 at a £20 000 willingness-to-pay threshold. Scenario analysis results suggest that only under very select conditions may anti-VEGFs offer potential for cost-effective treatment of PDR. The consequences of loss to follow-up were an important driver of model outcomes.
Conclusions: Anti-VEGFs are unlikely to be a cost-effective treatment for early PDR compared with PRP. Anti-VEGFs are generally associated with higher costs and similar health outcomes across various scenarios. Although anti-VEGFs were associated with lower diabetic macular edema rates, the number of cases avoided is insufficient to offset the additional treatment costs. Key uncertainties relate to the long-term comparative effectiveness of anti-VEGFs, particularly considering the real-world rates and consequences of treatment nonadherence. Further research on long-term visual acuity and rates of vision-threatening complications may be beneficial in resolving uncertainties.
Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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