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

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...

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Autores principales:	Ramsey DJ, Poulin SJ, LaMonica LC, Blaha GR, Barouch FC, Chang J, Marx JL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	diabetic macular edema socioeconomics diabetic retinopathy. Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/c3f5cb32380948d6abf569be614abdeb
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spelling	oai:doaj.org-article:c3f5cb32380948d6abf569be614abdeb2021-12-02T11:56:44ZEarly Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs1177-5483https://doaj.org/article/c3f5cb32380948d6abf569be614abdeb2021-01-01T00:00:00Zhttps://www.dovepress.com/early-conversion-to-aflibercept-for-persistent-diabetic-macular-edema--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483David 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 workCorrespondence: David J RamseyLahey Hospital & Medical Center, Tufts University School of Medicine, 1 Essex Center Drive, Peabody, MA 01960, USAEmail David.J.Ramsey@lahey.orgPurpose: 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 retinopathyRamsey DJPoulin SJLaMonica LCBlaha GRBarouch FCChang JMarx JLDove Medical Pressarticlediabetic macular edemasocioeconomicsdiabetic retinopathy.OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 31-39 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetic macular edema socioeconomics diabetic retinopathy. Ophthalmology RE1-994
spellingShingle	diabetic macular edema socioeconomics diabetic retinopathy. Ophthalmology RE1-994 Ramsey DJ Poulin SJ LaMonica LC Blaha GR Barouch FC Chang J Marx JL Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
description	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 workCorrespondence: David J RamseyLahey Hospital & Medical Center, Tufts University School of Medicine, 1 Essex Center Drive, Peabody, MA 01960, USAEmail David.J.Ramsey@lahey.orgPurpose: 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
format	article
author	Ramsey DJ Poulin SJ LaMonica LC Blaha GR Barouch FC Chang J Marx JL
author_facet	Ramsey DJ Poulin SJ LaMonica LC Blaha GR Barouch FC Chang J Marx JL
author_sort	Ramsey DJ
title	Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
title_short	Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
title_full	Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
title_fullStr	Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
title_full_unstemmed	Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs
title_sort	early conversion to aflibercept for persistent diabetic macular edema results in better visual outcomes and lower treatment costs
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/c3f5cb32380948d6abf569be614abdeb
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Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs

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