Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6. Issue 5 (May 2022)

• Record Type: Journal Article
• Authors: Simons, Rob W.P.; Wielders, Laura H.P.; Nuijts, Rudy M.M.A.; Veldhuizen, Claudette A.; van den Biggelaar, Frank J.H.M.; Winkens, Bjorn; Schouten, Jan S.A.G.; Dirksen, Carmen D.
• Is Part Of: Journal of cataract and refractive surgery. Volume 48:Issue 5(2022)
• Page Start: 555
• Page End: 563
• Publication Date: 2022-05
• Subjects: 617.7
• DOI: 10.1097/j.jcrs.0000000000000785
• Languages: English
• ISSNs: 0886-3350

Abstract

Abstract : The ESCRS PREMED study showed that perioperative subconjunctival triamcinolone acetonide was effective in prevention of pseudophakic cystoid macular edema in diabetic patients. This study confirmed that it is also cost-effective. Abstract : Purpose: To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema after cataract surgery in diabetic patients. Setting: 7 ophthalmology clinics in the Netherlands and Belgium. Design: Prospective trial-based cost-effectiveness analysis using data from a European multicenter randomized clinical trial. Methods: 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). Results: 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. Conclusions: In diabetic patients, subconjunctival triamcinolone was effective in preventing CSME after cataract surgery. The cost-effectiveness analysis showed that triamcinolone is also cost-effective.