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Economic evaluation of pharmacological strategies to prevent cystoid macular edema after cataract surgery in diabetic patients: results from the ESCRS PREMED study

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Session Details

Session Title: Cataract Surgery & Retinal Complications

Session Date/Time: Tuesday 25/09/2018 | 16:30-18:00

Paper Time: 16:36

Venue: Room A3, Podium 1

First Author: : R.Simons THE NETHERLANDS

Co Author(s): :    L. Wielders   C. Dirksen   F. van den Biggelaar   J. Schouten   B. Winkens   C. Veldhuizen     

Abstract Details


To evaluate the cost-effectiveness of various pharmaceutical strategies in preventing cystoid macular edema (CME) after cataract surgery in diabetic patients.


This study uses a subset of data from the European Society of Cataract and Refractive Surgeons (ESCRS) PREvention of Macular EDema after cataract surgery (PREMED) study, a multinational multicenter randomized clinical trial. Data for the economic evaluation were collected in seven ophthalmology clinics in the The Netherlands and Belgium.


144 eyes of 144 diabetic patients undergoing cataract surgery were included in the economic evaluation. All patients were treated with topical bromfenac and dexamethasone. Patients were randomized to receive: 1) perioperative subconjunctival injection of 40mg triamcinolone acetonide, 2) perioperative intravitreal injection of 1.25mg bevacizumab, 3) both injections, 4) control group (no additional treatment). Quality-adjusted life years (QALYs) were measured with the Health Utilities Index Mark-3. All relevant costs from a healthcare perspective were included. Follow-up was twelve weeks postoperatively. The primary outcome was the net monetary benefit (NMB). Uncertainty analyses were performed to determine cost-effectiveness probabilities for each treatment.


Total costs were €1810, €2043, €2018, and €2068 in the triamcinolone acetonide, bevacizumab, combination, and control group, respectively. QALYs were 0.17, 0.14, 0.16, and 0.16, respectively. Assuming decision-makers are willing to pay €20,000 per QALY (the standard rate in the The Netherlands for conditions with limited burden of disease), the NMB was €1515 (76% probability that intervention is cost-effective compared to other treatments) in the triamcinolone acetonide group, €666 (0%) in the bevacizumab group, €1226 (15%) in the combination group, and €1099 (9%) in the control group.


Costs were lowest in the triamcinolone acetonide group (€208 to €258 less) while QALYs were highest in that group. As a result, the cost-effectiveness analysis favored this treatment with a 76% probability of being cost-effective at a willingness-to-pay of €20.000 per QALY.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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