Economic evaluation of prevention of cystoid macular edema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Simons, Rob W.P.; Wielders, Laura H.P.; Dirksen, Carmen D.; Veldhuizen, Claudette A.; van den Biggelaar, Frank J.H.M.; Winkens, Bjorn; Schouten, Jan S.A.G.; Nuijts, Rudy M.M.A.
• Is Part Of: Journal of cataract and refractive surgery. Volume 47:Issue 3(2021)
• Page Start: 331
• Page End: 339
• Publication Date: 2021-03
• Subjects: 617.7
• DOI: 10.1097/j.jcrs.0000000000000449
• Languages: English
• ISSNs: 0886-3350

Abstract

Abstract : The ESCRS PREMED study showed that combination of topical NSAIDs and corticosteroids is most effective in prevention of pseudophakic cystoid macular edema. The current study confirms that it is also cost-effective. Abstract : Purpose: To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in patients without diabetes. Setting: Seven ophthalmology clinics in the Netherlands and Belgium. Design: Prospective cost-effectiveness analysis using data from a European multicenter randomized clinical trial (ESCRS PREMED). Methods: Patients without diabetes planned for expected uneventful cataract surgery were randomized to topical bromfenac (Yellox, n = 242), topical dexamethasone (n = 242), or a combination treatment (n = 238). All relevant resources from a healthcare perspective were included in the cost analysis within a time horizon of 12 weeks postoperatively. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) based on the cost per QALY. Results: The study comprised 722 patients without diabetes. Total healthcare costs and QALYs were € 447 (US $562) and 0.174 in the bromfenac group, €421 (US $529) and 0.179 in the dexamethasone group, and €442 (US $565) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was €6544 (US $8221) per QALY for the combination group compared with the dexamethasone group. Assuming that the willingness to pay is € 20 000 (US $25 126) per QALY, the cost-effectiveness probability was 3%, 32%, and 65% in the bromfenac, dexamethasone, and combination groups, respectively. Conclusions: In patients without diabetes, combination treatment with topical bromfenac and dexamethasone was effective and cost-effective in preventing CME after cataract surgery compared with treatment with either drug alone.