• Suzann Pershing, Eva A Enns, Brian Matesic, Douglas K Owens, and Jeremy D Goldhaber-Fiebert.
• Ann. Intern. Med. 2014 Jan 7; 160 (1): 182918-29.

BackgroundMacular edema is the most common cause of vision loss among patients with diabetes.ObjectiveTo determine the cost-effectiveness of different treatments of diabetic macular edema (DME).DesignMarkov model.Data SourcesPublished literature and expert opinion.Target PopulationPatients with clinically significant DME.Time HorizonLifetime.PerspectiveSocietal.InterventionLaser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both.Outcome MeasuresDiscounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).Results Of Base Case AnalysisAll 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.Results Of Sensitivity AnalysisVEGF 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.LimitationLong-term outcome data for treated and untreated diseases are limited.ConclusionThe 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.Primary Funding SourceAgency for Healthcare Research and Quality.

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