Cost-effectiveness of treatment of diabetic macular edema.
Cost-effectiveness of treatment of diabetic macular edema.
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DOI：
10.7326/m13-0768
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发表时间：
2014-01-07
影响因子：
39.2
通讯作者：
Goldhaber-Fiebert JD
中科院分区：
文献类型：
--
作者：
Pershing S;Enns EA;Matesic B;Owens DK;Goldhaber-Fiebert JD
黄斑水肿是糖尿病患者视力丧失的最常见原因。目的：探讨糖尿病性黄斑水肿（DME）不同治疗方法的成本-效果。马尔可夫模型。发表的文献和专家意见。临床上有明显二甲醚的患者。一生。社会。激光治疗，眼内注射曲安奈德或血管内皮生长因子（VEGF）抑制剂，或两者结合。贴现成本，质量调整寿命年（QALYs）的收益，增量成本效益比（ICERs）。除激光单药治疗外的所有治疗均大大降低了成本，除曲安奈德单药治疗外的所有治疗均增加了质量aly。与激光治疗+曲安奈德相比，激光治疗+ VEGF抑制剂获得了最大的益处，获得0.56 QALY，成本为6975美元，ICER为12410美元/ QALY。血管内皮生长因子抑制剂单药治疗与激光治疗加血管内皮生长因子抑制剂联合治疗的结果相似。激光单药治疗和曲安奈德单药治疗比联合治疗效果差，费用高。VEGF抑制剂单药治疗有时优于激光治疗加VEGF抑制剂，这取决于生活质量的降低和视力的丧失。当VEGF抑制剂贝伐单抗与雷尼单抗一样有效时，由于其成本较低，因此更可取。治疗和未治疗疾病的长期结果数据有限。最有效的治疗方法是血管内皮生长因子抑制剂注射和激光治疗。这种疗法与其他疾病的成本效益干预相比具有优势。医疗保健研究和质量机构。
Macular edema is the most common cause of visual loss among patients with diabetes. To determine the cost-effectiveness of different treatments of diabetic macular edema (DME). Markov model. Published literature and expert opinion. Patients with clinically significant DME. Lifetime. Societal. Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both. Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). All 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. VEGF 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 to because of its lower cost. Long-term outcome data for treated and untreated diseases are limited. The 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. Agency for Healthcare Research and Quality.