This cost-utility analysis compared 3 primary treatments for proliferative diabetic retinopathy (PDR): pars plana vitrectomy (PPV), laser and ranibizumab.
Study design
Using data from the Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol S, investigators modeled the 2-year costs for 3 treatment scenarios: early PPV, panretinal photocoagulation (PRP) and intravitreal ranibizumab (0.3 mg).
The analysis was based on treating PDR patients without diabetic macular edema.
Outcomes
The modeled cost per quality-adjusted life years (QALY) in a hospital-based facility was $181,144 for PPV, $163,988 for PRP and $436,992 for ranibizumab.
Early PPV maintained a similar cost-utility to PRP over a lifetime of treatment ($63,942 vs. $61,695). However, the difference between PPV and ranibizumab continued to increase over a lifetime of treatment, presumably because the ranibizumab group requires more annual injections than the PPV group.
Limitations
The cost of managing complications from various treatments were not considered. For example, injections may cause endophthalmitis and PPV may cause cataract. These may impact cost in a given patient of one treatment versus another.
Clinical significance
Early PPV as a strategy for treatment of PDR without macular edema demonstrates a similar cost-utility to PRP and had a more favorable cost-utility compared with ranibizumab. This advantage for PPV over ranibizumab continued over a lifetime of treatment.
All treatment scenarios were above the acceptable range of $50,000 to $100,000/QALY when considering cost-utility for 2 years. Both PRP and early PPV fall within the acceptable lifetime cost/QALY range, whereas ranibizumab still exceeds this limit.