Abstract
BackgroundDiabetic macular oedema (DMO) may lead to visual loss and blindness. Several pharmacological treatments are available on the National Health Service (NHS) to United Kingdom patients affected by this condition, including intravitreal vascular endothelial growth factor inhibitors (anti-VEGFs) and two types of intravitreal steroid implants, releasing dexamethasone or fluocinolone acetonide (FAc). This study aimed to assess the value for money (cost-effectiveness) of the FAc 0.2 μg/day implant (ILUVIEN®) in patients with chronic DMO considered insufficiently responsive to other therapies.MethodsWe developed a Markov model with a 15-year time horizon to estimate the impact of changes in best-corrected visual acuity in DMO patients on costs and quality-adjusted life years. The model considered both eyes, designated as the “study eye”, defined at model entry as phakic with an ongoing cataract formation or pseudophakic, and the “fellow eye”. The model compared the FAc 0.2 μg/day implant with a 700 μg dexamethasone implant (pseudophakic patients only) or with usual care, defined as a mixture of laser photocoagulation and anti-VEGFs (phakic and pseudophakic patients). Costs were estimated from the perspective of the NHS and Personal Social Services; full NHS prices were used for drugs.ResultsIn patients who were pseudophakic at baseline, at 36 months, the FAc implant provided an additional gain of 4.01 and 3.64 Early Treatment Diabetic Retinopathy Study (ETDRS) letters compared with usual care and the dexamethasone implant, respectively. Over the 15-year time horizon, this translated into 0.185 additional quality-adjusted life years (QALYs) at an extra cost of £3066 compared with usual care, and 0.126 additional QALYs at an extra cost of £1777 compared with dexamethasone. Thus, incremental cost-effectiveness ratios (ICERs) were £16,609 and £14,070 per QALY gained vs. usual care and dexamethasone, respectively. In patients who were phakic at baseline, the FAc 0.2 μg/day implant provided an additional gain of 2.96 ETDRS letters at 36 months compared with usual care, which, over 15 years, corresponded to 0.11 additional QALYs at an extra cost of £3170, resulting in an ICER of £28,751 per QALY gained.ConclusionThe FAc 0.2 μg/day implant provided good value for money compared with other established treatments, especially in pseudophakic patients.
Highlights
Diabetic macular oedema (DMO) may lead to visual loss and blindness
The average number of quality-adjusted life years (QALYs) in patients treated with the fluocinolone acetonide (FAc) 0.2 μg/day implant was 5.776 over the 15-year model time horizon – an additional 0.185 QALYs compared with usual care (UC), which was associated with 5.592 QALYs
With a base-case incremental cost-effectiveness ratios (ICERs) of £16,609 and £28,751 per QALY in pseudophakic and phakic patients, the FAc 0.2 μg/day implant was estimated to be cost-effective compared with usual care, considering that a cost-effectiveness threshold of £20,000–£30,000 per QALY is normally applied in the UK [27]
Summary
Diabetic macular oedema (DMO) may lead to visual loss and blindness. Several pharmacological treatments are available on the National Health Service (NHS) to United Kingdom patients affected by this condition, including intravitreal vascular endothelial growth factor inhibitors (anti-VEGFs) and two types of intravitreal steroid implants, releasing dexamethasone or fluocinolone acetonide (FAc). In the UK, almost 3.6 million people are living with this disease [2] Those suffering from diabetes may experience long-term complications impacting various parts of the body, including kidney failure, cardiovascular events, lower extremity amputations and loss of vision [1]. The latter is related to diabetic retinopathy, which affects approximately 35% of diabetics, threatening the vision of 7% [1]. DMO is the most common cause of moderate visual loss from diabetic retinopathy [4], with an estimated age-standardised prevalence of 6.81% amongst patients with diabetes [5]. Recent studies from the UK reported an estimated DMO prevalence of 7.12% amongst diabetics in England (with the condition affecting both eyes in 2.34% of diabetes patients) [6, 7]
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