Bevacizumab-first treatment strategy may be more cost-effective in DME

Treatment with bevacizumab in eyes with vision loss from diabetic macular edema (DME) before switching to aflibercept in the case of poor response may provide substantial cost savings on a societal level, according to an article published in JAMA Ophthalmology.

Data from 228 participants of a randomized clinical trial with center-involved DME and best-corrected visual acuity of 20/50 to 20/320 were analyzed to evaluate costs related to aflibercept monotherapy (n = 116) versus bevacizumab-first strategies (n = 112). Overall, 62.5% of participants in the bevacizumab-first strategies switched to aflibercept.

Over the 2-year study period, aflibercept monotherapy cost $12 575 more than bevacizumab-first therapy ($26 504 vs $13 929), however, it had an incremental cost-effectiveness ratio of $837 077 per quality-adjusted life-year gained compared with bevacizumab first.

Reference
Hutton DW, Glassman AR, Liu D, et al; DRCR Retina Network. Cost-effectiveness of Aflibercept Monotherapy vs Bevacizumab First Followed by Aflibercept If Needed for Diabetic Macular Edema. JAMA Ophthalmol. Published online February 02, 2023. doi:10.1001/jamaophthalmol.2022.6142