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Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs

Authors Ramsey DJ, Poulin SJ, LaMonica LC, Blaha GR, Barouch FC, Chang J, Marx JL

Received 16 October 2020

Accepted for publication 17 December 2020

Published 8 January 2021 Volume 2021:15 Pages 31—39


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

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 work

Correspondence: David J Ramsey
Lahey Hospital & Medical Center, Tufts University School of Medicine, 1 Essex Center Drive, Peabody, MA 01960, USA

Purpose: 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

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