Suzann Pershing, MD, MS; Eva A. Enns, MS, PhD; Brian Matesic, BS; Douglas K. Owens, MD, MS; Jeremy D. Goldhaber-Fiebert, PhD
This material was presented at the 34th Annual Meeting of the Society of Medical Decision Making, Phoenix, Arizona, 17–19 October 2012.
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Acknowledgment: The authors thank Dr. Mark S. Blumenkranz for guidance and manuscript review.
Financial Support: By grant T32-HS000028 from the Agency for Healthcare Research and Quality and a National Institutes of Health National Institute on Aging Career Development Award (K01 AG037593-01A1; Dr. Goldhaber-Fiebert, principal investigator). Dr. Owens was supported by the U.S. Department of Veterans Affairs. This research was also supported in part by the Office of the Dean, Stanford Medical School, Stanford Society of Physician Scholars.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0768.
Reproducible Research Statement: Study protocol, statistical code, and data set: Available from Dr. Pershing (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Suzann Pershing, MD, MS, 2452 Watson Court, Palo Alto, CA 94303; e-mail, email@example.com.
Current Author Addresses: Dr. Pershing: 2452 Watson Court, Palo Alto, CA 94303.
Dr. Enns: University of Minnesota, Division of Health Policy and Management, MMC 729 Mayo, Campus Mail Code 8729A, 420 Delaware Street SE, Minneapolis, MN 55455.
Mr. Matesic: 316 Grant Avenue, Palo Alto, CA 94306.
Dr. Owens and Goldhaber-Fiebert: Stanford University, Center for Health Policy and Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford, CA 94305.
Author Contributions: Conception and design: S. Pershing, J.D. Goldhaber-Fiebert, D.K. Owens.
Analysis and interpretation of the data: S. Pershing, E.A. Enns, J.D. Goldhaber-Fiebert.
Drafting of the article: S. Pershing,
Critical revision of the article for important intellectual content: S. Pershing, E.A. Enns, J.D. Goldhaber-Fiebert, D.K. Owens.
Final approval of the article: S. Pershing, E.A. Enns, J.D. Goldhaber-Fiebert, D.K. Owens, B. Matesic.
Provision of study materials or patients:
Statistical expertise: S. Pershing, E.A. Enns, J.D. Goldhaber-Fiebert.
Obtaining of funding:
Administrative, technical, or logistic support:
Collection and assembly of data: S. Pershing.
Macular edema is the most common cause of vision loss among patients with diabetes.
To determine the cost-effectiveness of different treatments of diabetic macular edema (DME).
Published literature and expert opinion.
Patients with clinically significant DME.
Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both.
Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
All treatments except laser monotherapy substantially reduced costs, and all treatments except triamcinolone monotherapy increased QALYs. Laser treatment plus a VEGF inhibitor achieved the greatest benefit, gaining 0.56 QALYs at a cost of $6975 for an ICER of $12 410 per QALY compared with laser treatment plus triamcinolone. Monotherapy with a VEGF inhibitor achieved similar outcomes to combination therapy with laser treatment plus a VEGF inhibitor. Laser monotherapy and triamcinolone monotherapy were less effective and more costly than combination therapy.
VEGF inhibitor monotherapy was sometimes preferred over laser treatment plus a VEGF inhibitor, depending on the reduction in quality of life with loss of visual acuity. When the VEGF inhibitor bevacizumab was as effective as ranibizumab, it was preferable because of its lower cost.
Long-term outcome data for treated and untreated diseases are limited.
The most effective treatment of DME is VEGF inhibitor injections with or without laser treatment. This therapy compares favorably with cost-effective interventions for other conditions.
Agency for Healthcare Research and Quality.
Pershing S, Enns EA, Matesic B, Owens DK, Goldhaber-Fiebert JD. Cost-Effectiveness of Treatment of Diabetic Macular Edema. Ann Intern Med. ;160:18–29. doi: 10.7326/M13-0768
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Published: Ann Intern Med. 2014;160(1):18-29.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Healthcare Delivery and Policy.
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