Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6

Rob W P Simons; Laura H P Wielders; Rudy M M A Nuijts; Claudette A Veldhuizen; Frank J H M van den Biggelaar; Bjorn Winkens; Jan S A G Schouten; Carmen D Dirksen; Willem R O Goslings; Marie-José Tassignon; Maurits V Joosse; Ype P Henry; Alexander H F Rulo; ESCRS PREMED Study Group

doi:10.1097/j.jcrs.0000000000000785

Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6

Rob W P Simons^*
, Laura H P Wielders
, Rudy M M A Nuijts
, Claudette A Veldhuizen
, Frank J H M van den Biggelaar
, Bjorn Winkens
, Jan S A G Schouten
, Carmen D Dirksen
, Willem R O Goslings
, Marie-José Tassignon
, Maurits V Joosse
, Ype P Henry
, Alexander H F Rulo
, ESCRS PREMED Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in diabetic patients.

SETTING: Seven 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 uncomplicated 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: Mean total healthcare costs and QALYs were: Triamcinolone € 1827 (US$ 2295) / 0.166; Bevacizumab € 2050 (US$ 2575) / 0.144; Combination € 2027 (US$ 2546) / 0.166; Control € 2041 (US$ 2564) / 0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was € 321,984 (US$ 404,503) per QALY for the combination group compared to the triamcinolone group. Assuming the willingness-to-pay is € 20,000 (US$ 25,126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient that 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 triamcinolone is also cost-effective.

Original language	English
Pages (from-to)	555-563
Number of pages	9
Journal	Journal of Cataract and Refractive Surgery
Volume	48
Issue number	5
Early online date	18 Aug 2021
DOIs	https://doi.org/10.1097/j.jcrs.0000000000000785
Publication status	Published - May 2022

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Simons, R. W. P., Wielders, L. H. P., Nuijts, R. M. M. A., Veldhuizen, C. A., van den Biggelaar, F. J. H. M., Winkens, B., Schouten, J. S. A. G., Dirksen, C. D., Goslings, W. R. O., Tassignon, M.-J., Joosse, M. V., Henry, Y. P., Rulo, A. H. F., & ESCRS PREMED Study Group (2022). Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6. Journal of Cataract and Refractive Surgery, 48(5), 555-563. https://doi.org/10.1097/j.jcrs.0000000000000785

@article{f7c1a1caa7514577a678308c9bf1c248,

title = "Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6",

abstract = "PURPOSE: To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in diabetic patients.SETTING: Seven 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 uncomplicated 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: Mean total healthcare costs and QALYs were: Triamcinolone € 1827 (US\$ 2295) / 0.166; Bevacizumab € 2050 (US\$ 2575) / 0.144; Combination € 2027 (US\$ 2546) / 0.166; Control € 2041 (US\$ 2564) / 0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was € 321,984 (US\$ 404,503) per QALY for the combination group compared to the triamcinolone group. Assuming the willingness-to-pay is € 20,000 (US\$ 25,126) per QALY, the cost-effectiveness probability was 70\% and 23\% in the triamcinolone and combination groups, respectively. No patient that 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 triamcinolone is also cost-effective.",

author = "Simons, \{Rob W P\} and Wielders, \{Laura H P\} and Nuijts, \{Rudy M M A\} and Veldhuizen, \{Claudette A\} and \{van den Biggelaar\}, \{Frank J H M\} and Bjorn Winkens and Schouten, \{Jan S A G\} and Dirksen, \{Carmen D\} and Goslings, \{Willem R O\} and Marie-Jos{\'e} Tassignon and Joosse, \{Maurits V\} and Henry, \{Ype P\} and Rulo, \{Alexander H F\} and \{ESCRS PREMED Study Group\}",

note = "Copyright {\textcopyright} 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.",

year = "2022",

month = may,

doi = "10.1097/j.jcrs.0000000000000785",

language = "English",

volume = "48",

pages = "555--563",

journal = "Journal of Cataract and Refractive Surgery",

issn = "0886-3350",

publisher = "Lippincott Williams \& Wilkins",

number = "5",

}

Simons, RWP, Wielders, LHP, Nuijts, RMMA, Veldhuizen, CA, van den Biggelaar, FJHM , Winkens, B , Schouten, JSAG , Dirksen, CD, Goslings, WRO, Tassignon, M-J, Joosse, MV, Henry, YP, Rulo, AHF & ESCRS PREMED Study Group 2022, 'Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6', Journal of Cataract and Refractive Surgery, vol. 48, no. 5, pp. 555-563. https://doi.org/10.1097/j.jcrs.0000000000000785

TY - JOUR

T1 - Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients

T2 - ESCRS PREMED study report 6

AU - Simons, Rob W P

AU - Wielders, Laura H P

AU - Nuijts, Rudy M M A

AU - Veldhuizen, Claudette A

AU - van den Biggelaar, Frank J H M

AU - Winkens, Bjorn

AU - Schouten, Jan S A G

AU - Dirksen, Carmen D

AU - Goslings, Willem R O

AU - Tassignon, Marie-José

AU - Joosse, Maurits V

AU - Henry, Ype P

AU - Rulo, Alexander H F

AU - ESCRS PREMED Study Group

PY - 2022/5

Y1 - 2022/5

N2 - PURPOSE: To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in diabetic patients.SETTING: Seven 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 uncomplicated 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: Mean total healthcare costs and QALYs were: Triamcinolone € 1827 (US$ 2295) / 0.166; Bevacizumab € 2050 (US$ 2575) / 0.144; Combination € 2027 (US$ 2546) / 0.166; Control € 2041 (US$ 2564) / 0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was € 321,984 (US$ 404,503) per QALY for the combination group compared to the triamcinolone group. Assuming the willingness-to-pay is € 20,000 (US$ 25,126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient that 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 triamcinolone is also cost-effective.

AB - PURPOSE: To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in diabetic patients.SETTING: Seven 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 uncomplicated 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: Mean total healthcare costs and QALYs were: Triamcinolone € 1827 (US$ 2295) / 0.166; Bevacizumab € 2050 (US$ 2575) / 0.144; Combination € 2027 (US$ 2546) / 0.166; Control € 2041 (US$ 2564) / 0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was € 321,984 (US$ 404,503) per QALY for the combination group compared to the triamcinolone group. Assuming the willingness-to-pay is € 20,000 (US$ 25,126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient that 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 triamcinolone is also cost-effective.

U2 - 10.1097/j.jcrs.0000000000000785

DO - 10.1097/j.jcrs.0000000000000785

M3 - Article

C2 - 34417781

SN - 0886-3350

VL - 48

SP - 555

EP - 563

JO - Journal of Cataract and Refractive Surgery

JF - Journal of Cataract and Refractive Surgery

IS - 5

ER -

Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6

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