Clinical Ophthalmology (Jan 2021)
Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
Abstract
David J Ramsey,1,* Samuel J Poulin,1,* Lauren C LaMonica,2 Gregory R Blaha,1 Fina C Barouch,1 Jeffrey Chang,1 Jeffrey L Marx1 1Division of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, Peabody, MA 01960, USA; 2University of Michigan Medical School, Ann Arbor, MI 48109, USA*These authors contributed equally to this workCorrespondence: David J RamseyLahey Hospital & Medical Center, Tufts University School of Medicine, 1 Essex Center Drive, Peabody, MA 01960, USAEmail [email protected]: To evaluate the functional and anatomic outcomes, as well as cost-effectiveness, of the timing of conversion to intravitreal aflibercept (IVA) in patients with treatment-resistant diabetic macular edema (DME).Methods: Thirty consecutive eyes (25 patients) were identified that were treated with ≥ 3 intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) injections prior to treatment with ≥ 3 IVA injections. Eyes that received ≤ 6 IVB and/or IVR injections (early-switch) were compared to those that received ≥ 7 injections (late-switch) prior to conversion to IVA. Treatment effectiveness was measured in quality-adjusted life years (QALYs). A micro-simulation model examined the impact of treatment duration on outcomes.Results: Early- (n=18) and late- (n=12) switch eyes had similar vision prior to conversion to IVA. Despite improvements in retinal thickness, only the early-switch eyes maintained vision gains after conversion to IVA through the end of follow-up (p=0.027). Early switch saved $22,884/eye and produced an additional 0.027 QALYs.Conclusion: Early conversion to IVA optimizes vision outcomes and results in lower overall treatment expenditures.Keywords: diabetic macular edema; DME, socioeconomics, diabetic retinopathy
