Anti–Vascular Endothelial Growth Factor Drugs Compared With Panretinal Photocoagulation for the Treatment of Proliferative Diabetic Retinopathy: A Cost-Effectiveness Analysis

• Published in: Value in health 2024-07, Vol.27 (7), p.907-917
• Main Authors: Walton, Matthew, Bojke, Laura, Simmonds, Mark, Walker, Ruth, Llewellyn, Alexis, Fulbright, Helen, Dias, Sofia, Stewart, Lesley A., Rush, Tom, Steel, David H., Lawrenson, John G., Peto, Tunde, Hodgson, Robert
• Format: Article
• Language: English
• Subjects: aflibercept; anti-VEGF; diabetic retinopathy; discrete event simulation; IPD meta-analysis; ranibizumab
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2024.03.007

This study aimed to evaluate the cost-effectiveness of anti–vascular endothelial growth factor drugs (anti-VEGFs) compared with panretinal photocoagulation (PRP) for treating proliferative diabetic retinopathy (PDR) in the United Kingdom. A discrete event simulation model was developed, informed by individual participant data meta-analysis. The model captures treatment effects on best corrected visual acuity in both eyes, and the occurrence of diabetic macular edema and vitreous hemorrhage. The model also estimates the value of undertaking further research to resolve decision uncertainty. Anti-VEGFs are unlikely to generate clinically meaningful benefits over PRP. The model predicted anti-VEGFs be more costly and similarly effective as PRP, generating 0.029 fewer quality-adjusted life-years at an additional cost of £3688, with a net health benefit of −0.214 at a £20 000 willingness-to-pay threshold. Scenario analysis results suggest that only under very select conditions may anti-VEGFs offer potential for cost-effective treatment of PDR. The consequences of loss to follow-up were an important driver of model outcomes. Anti-VEGFs are unlikely to be a cost-effective treatment for early PDR compared with PRP. Anti-VEGFs are generally associated with higher costs and similar health outcomes across various scenarios. Although anti-VEGFs were associated with lower diabetic macular edema rates, the number of cases avoided is insufficient to offset the additional treatment costs. Key uncertainties relate to the long-term comparative effectiveness of anti-VEGFs, particularly considering the real-world rates and consequences of treatment nonadherence. Further research on long-term visual acuity and rates of vision-threatening complications may be beneficial in resolving uncertainties. •Proliferative diabetic retinopathy (PDR) is a leading cause of visual impairment and blindness in the United Kingdom and worldwide. Anti–vascular endothelial growth factor (anti-VEGF) drugs aflibercept and ranibizumab are recommended by the National Institute for Health and Care Excellence for the treatment of various eye conditions, including diabetic macular edema, and have shown promise as an alternative treatment for PDR.•There is limited evidence on the cost-effectiveness of anti-VEGFs for the treatment of diabetic retinopathy. This study reports discrete event simulation–based cost-effectiveness analysis in which we evaluate the cost-effectiveness of anti-VEGFs compared with pan