Economic evaluation of prevention of cystoid macular edema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4

Rob W. P. Simons*, Laura H. P. Wielders, Carmen D. Dirksen, Claudette A. Veldhuizen, Frank J. H. M. van den Biggelaar, Bjorn Winkens, Jan S. A. G. Schouten, Rudy M. M. A. Nuijts, ESCRS PREMED Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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 euro 447 (US $562) and 0.174 in the bromfenac group, euro421 (US $529) and 0.179 in the dexamethasone group, and euro442 (US $565) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was euro6544 (US $8221) per QALY for the combination group compared with the dexamethasone group. Assuming that the willingness to pay is euro 20000 (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.

J Cataract Refract Surg 2021; 47:331-339 Copyright (c) 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS

Original languageEnglish
Pages (from-to)331-339
Number of pages9
JournalJournal of Cataract and Refractive Surgery
Issue number3
Publication statusPublished - Mar 2021



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