José M. Ruiz‑Moreno y Jorge Ruiz‑Medrano
Abstract
Background: To evaluate the cost-efectiveness of early- versus late-switch to the intravitreal-dexamethasone implant (DEXi) 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 <0.0001). Regarding incremental-cost-efectiveness ratio, late-switch group was associated with an incremental cost of €25,735.2 and €13,533.2 for achieving a BCVA improvement≥0.1 at month 12 and at any of the time-point measured, respectively. At month 12, 38 (35.2%) eyes achieved a BCVA improvement≥0.1. At month 12, 52 (48.1) eyes had achieved a CRT≤250 micron. As compared to baseline, the mean (95% CI) CRT reduction was−163.1 (−212.5 to−113.7) µm and−161.6 (−183.8 to−139.3) µm in the early-switch and late-switch groups, respectively, p=0.9463.
Conclusions: In DME eyes, who did not adequately respond to anti-VEGF, switching to DEX-i at early stages (after the frst 3-monthly injections) was found to be more cost-efective than extending the treatment to 6-monthly injections of anti-VEGF.
