Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

• Published in: Graefe's archive for clinical and experimental ophthalmology 2023-04, Vol.261 (4), p.941-949
• Main Authors: Ruiz-Moreno, José M., Ruiz-Medrano, Jorge
• Format: Article
• Language: English
• Subjects: Acuity; Cost analysis; Cost-Benefit Analysis; Dexamethasone; Diabetes; Diabetes mellitus; Diabetes Mellitus - drug therapy; Diabetic Retinopathy - complications; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - drug therapy; Drug Implants - therapeutic use; Edema; Eye; Glucocorticoids; Humans; Intravitreal Injections; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - etiology; Medicine; Medicine & Public Health; Ophthalmology; Patients; Retina; Retinal Disorders; Retrospective Studies; Steroids; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-022-05892-3

    Background To evaluate the cost-effectiveness of early- versus late-switch to the intravitreal-dexamethasone implant (DEX-i) in patients with diabetic macular edema (DME) who did not adequately respond to vascular endothelial growth factor inhibitors (anti-VEGF). Methods Retrospective analysis of a multicenter Clinical Data Registry. The registry included DME eyes who received 3 intravitreal anti-VEGF injections (early-switch) or > 3 intravitreal anti-VEGF injections (late-switch) before switching to DEX-i injections. The primary outcome was to estimate the incremental cost needed to obtain a best-corrected visual acuity (BCVA) improvement ≥ 0.1 or a central-retinal thickness CRT ≤ 250 μm. Results The analysis included 108 eyes, 32 (29.6%) and 76 (70.4%) in the early- and late-switch groups, respectively. Early-switch strategy was associated with a cost saving of €3,057.8; 95% CI: €2,406.4–3,928.4, p