Healthcare expenditure of intravitreal anti‐vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema

Hertzberg, Silvia Nw; Moe, Morten C.; Jørstad, Øystein Kalsnes; Petrovski, Beáta Éva; Burger, Emily A.; Petrovski, Goran

doi:10.1111/aos.15151

Cited by 3 publications

(1 citation statement)

References 50 publications

(126 reference statements)

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“…Even though some studies have suggested decreasing the frequencies of IVIs in this patient group, frequent use may be beneficial, depending on the drug administered. For instance, the dexamethasone implant has prolonged efficacy (an average of 3 injections per year), though it may require further visits to manage intraocular pressure-related issues [10,15,33,[46][47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective

Hertzberg

Jørstad

Petrovski

et al. 2022

IJERPH

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Purpose: To describe the trends in hospital utilization and economic outcomes associated with the transition from laser to intravitreal injection (IVI) therapy for diabetic retinopathy (DR) at Oslo University Hospital (OUH), which provides the largest retina service in Norway. Methods: This descriptive study analyzed hospital administrative data and determined the average utilization and treatment proportions of laser therapy, IVIs and vitrectomy for each patient per year. The Chi-square test was used to compare resource use between treatment groups. From an extended healthcare perspective, the annual cost per patient was calculated using Norwegian tariff data from 2020 and the National Medication Price Registry for patients seen between 2010 and 2018. Bootstrapping was performed to generate 95% confidence intervals for the cost per patient per year. Results: Among the 1838 (41% female) patients treated for DR between 2005 and 2018, OUH provided on average 1.09 laser treatments per DR patient and 0.54 vitrectomies per DR patient in 2005, whose utilization declined to 0.54 and 0.05 treatments per DR patient, respectively, by 2018. Laser treatments declined from 64% to 10%, while vitrectomies declined from 32% to 1%. In contrast, IVI treatments increased from 4.5% to 89% of the total share, representing an average increase, from 0.08 injections per patient in 2005 to 4.73 injections per patient in 2018. Both the increasing number of DR patients and the shift in the type of treatment increased the economic costs of treating DR from a total of EUR 0.605 million (EUR 2935 per patient) in 2010 to EUR 2.240 million (EUR 3665 per patient) in 2018, with IVIs contributing considerably to these costs. Conclusions: Despite the decline in the use of vitrectomies, the transition from laser to IVI therapy for DR increased the healthcare resource utilization and economic costs of its treatment over the observed time. A main cost driver was the need for long-term IVIs, in addition to the drug cost itself. Trade-offs can be achieved through effective alternative IVI delivery or appropriate drug choice that balances patient needs with the economic burden of treating DR.

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Section: Discussionmentioning

confidence: 99%

Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective

Hertzberg

Jørstad

Petrovski

et al. 2022

IJERPH

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Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion

Galvez-Olortegui,

Bouchikh-El Jarroudi,

Silva-Ocas

et al. 2024

Eye

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Background/Objectives:To assess the Clinical Practice Guidelines (CPG) for the diagnosis and management of Retinal Vein Occlusion (RVO). Methods:A systematic review of CPGs for the diagnosis and management of RVO, published between January-2010 and April-2022, was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories.CPGs in English/Spanish were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation(AGREE-II) instrument. An individual assessment of each CPG by domain(AGREE-II), an overall assessment of the guide, and its use with or without modi cations was performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out. Results:5/6 CPGs scored low in domain 3(rigour of development), and the highest score(mean 62%) was for domain 4(clarity of presentation). 2019 American guideline (PPP) presented the best score(40.4%) in domain 3. When evaluating the overall quality of the CPGs analyzed, all CPGs could be recommended with modi cations. In the meta-synthesis, anti-VEGF therapy is the rst-choice therapy for macular edema associated with RVO, but there is no clear recommendation about the type of anti-VEGF therapy to choose. Recommendations for diagnosis and follow-up are similar among CPGs evaluated. Conclusion:Most CPGs for the diagnosis and management of retinal vein occlusion have a low methodological quality evaluated according to the AGREE-II. PPP has the higher score in the domain "Rigour of Development". Among the CPGs evaluated, there is no clear recommendation on the type of anti-VEGF therapy to choose.

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Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion

Galvez-Olortegui,

Jarroudi,

Silva-Ocas

et al. 2023

Preprint

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Background/Objectives: To assess the Clinical Practice Guidelines (CPG) for the diagnosis and management of Retinal Vein Occlusion (RVO). Methods: A systematic review of CPGs for the diagnosis and management of RVO, published between January-2010 and April-2022, was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories.CPGs in English/Spanish were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation(AGREE-II) instrument. An individual assessment of each CPG by domain(AGREE-II), an overall assessment of the guide, and its use with or without modifications was performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out. Results: 5/6 CPGs scored low in domain 3(rigour of development), and the highest score(mean 62%) was for domain 4(clarity of presentation). 2019 American guideline (PPP) presented the best score(40.4%) in domain 3. When evaluating the overall quality of the CPGs analyzed, all CPGs could be recommended with modifications. In the meta-synthesis, anti-VEGF therapy is the first-choice therapy for macular edema associated with RVO, but there is no clear recommendation about the type of anti-VEGF therapy to choose. Recommendations for diagnosis and follow-up are similar among CPGs evaluated. Conclusion: Most CPGs for the diagnosis and management of retinal vein occlusion have a low methodological quality evaluated according to the AGREE-II. PPP has the higher score in the domain “Rigour of Development”. Among the CPGs evaluated, there is no clear recommendation on the type of anti-VEGF therapy to choose.

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Healthcare expenditure of intravitreal anti‐vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema

Cited by 3 publications

References 50 publications

Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective

Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective

Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion

Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion

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