J Cataract Refract Surg 2020 Sep 24. Epub 2020 Sep 24.
From the University Eye Clinic Maastricht, Maastricht University Medical Center+ (Simons, Wielders, Veldhuizen, van den Biggelaar, Schouten, Nuijts), Maastricht, The Netherlands, Department of Ophthalmology, Zuyderland Medical Center Heerlen (Simons, Wielders, Schouten, Nuijts), Sittard-Geleen, The Netherlands, Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (Dirksen), Maastricht, The Netherlands, Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (Winkens), The Netherlands, Department of Ophthalmology, Canisius Wilhelmina Hospital (Schouten), Nijmegen, The Netherlands.
Purpose: To investigate the cost-effectiveness of prophylactic treatments against cystoid macula edema (CME) after cataract surgery in nondiabetic patients.
Setting: Seven ophthalmology clinics in the Netherlands and Belgium.
Design: Prospective cost-effectiveness analysis using data from a European multicenter randomized clinical trial (ESCRS PREMED).
Methods: Nondiabetic patients planned for expected uncomplicated cataract surgery were randomized to topical bromfenac (Yellox, n=242), topical dexamethasone (n=242), or a combination treatment (n=238). All relevant resources from a healthcare perspective were included in the cost analysis within a time horizon of 12 weeks postoperatively. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) based on the cost per QALY.
Results: The study comprised 722 nondiabetic patients. Total healthcare costs and QALYs were &OV0556; 447 (US$ 562) and 0.174 in the bromfenac group, &OV0556; 421 (US$ 529) and 0.179 in the dexamethasone group, and &OV0556; 442 (US$ 555) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was &OV0556; 6544 (US$ 8221) per QALY for the combination group compared to the dexamethasone group. Assuming the willingness-to-pay is &OV0556; 20,000 (US$ 25,126) per QALY, the cost-effectiveness probability was 3%, 32%, and 65% in the bromfenac, dexamethasone, and combination groups, respectively.
Conclusions: In nondiabetic patients, combination treatment with topical bromfenac and dexamethasone was effective and cost-effective in preventing CME after cataract surgery, compared to treatment with either drug alone.