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Cost-effectiveness of dexamethasone and triamcinolone for the treatment of diabetic macular oedema in Finland: A Markov-model.
- Source :
-
Acta ophthalmologica [Acta Ophthalmol] 2021 Nov; Vol. 99 (7), pp. e1146-e1153. Date of Electronic Publication: 2021 Jan 09. - Publication Year :
- 2021
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Abstract
- Purpose: Diabetic macular oedema (DMO), a complication of diabetes, causes vision loss and blindness. Corticosteroids are usually used as a second-line treatment. The aim of this study was to analyse the cost-effectiveness of dexamethasone implants compared to cheaper and more frequently applied triamcinolone injections.<br />Methods: Markov-modelling, which incorporated both eyes, was used for economic evaluation. The model consisted of five health states based on visual acuity, illustrating the progression of DMO. A cycle length of five months was chosen for dexamethasone and four months for triamcinolone. Time horizons of two and five years were applied. Transition probabilities and health state utilities were sourced from previous studies. The perspective used in this analysis was the hospital perspective. The health care costs were acquired from Kuopio University Hospital in Finland.<br />Results: In this cost-effectiveness analysis, the incremental cost-effectiveness ratio ICER with 3% discount rate was €56 591/QALY for a two-year follow-up and -€1 110 942/QALY for a five-year follow-up. In order to consider dexamethasone as cost-effective over a 2-year time horizon, the WTP needs to be around €55 000/QALY. Over the five-year follow-up, triamcinolone is clearly a dominant treatment. Sensitivity analyses support the cost-effectiveness of dexamethasone over a 2-year time horizon.<br />Conclusions: Since the sensitivity analyses support the results, dexamethasone would be a cost-effective treatment during the first two years with WTP threshold around €55 000/QALY, and triamcinolone would be a convenient treatment after that. This recommendation is in line with the guidelines of EURETINA.<br /> (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)
- Subjects :
- Aged
Cost-Benefit Analysis
Dexamethasone administration & dosage
Diabetic Retinopathy complications
Diabetic Retinopathy drug therapy
Disease Progression
Finland
Follow-Up Studies
Glucocorticoids administration & dosage
Glucocorticoids economics
Humans
Macular Edema drug therapy
Macular Edema etiology
Quality-Adjusted Life Years
Time Factors
Treatment Outcome
Triamcinolone administration & dosage
Dexamethasone economics
Diabetic Retinopathy economics
Health Care Costs statistics & numerical data
Macular Edema economics
Markov Chains
Triamcinolone economics
Visual Acuity
Subjects
Details
- Language :
- English
- ISSN :
- 1755-3768
- Volume :
- 99
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Acta ophthalmologica
- Publication Type :
- Academic Journal
- Accession number :
- 33421332
- Full Text :
- https://doi.org/10.1111/aos.14745