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Ophthalmologists advised to weigh costs of diabetic retinopathy treatment

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KOLOA, Hawaii — Less expensive alternatives for treating diabetic retinopathy should be explored in some subgroups of patients, according to a speaker here.

“This is really a privileged time to have all these different options for treating diabetic retinopathy. Of course, the anti-VEGF options are the centerpiece for this,” William E. Smiddy, MD, said at Retina 2017. “The elephant in the room is that long-term injection [therapy] is very expensive...There are some circumstances where we can be a little more responsible with our resources because we can’t continue to ignore these high costs.”

William E. Smiddy

The cost of different anti-VEGF treatments can vary greatly, especially over a lifetime, according to Smiddy, and the cost-effectiveness must be considered.

“The fact of the matter is, Washington is paying a lot of attention to this and they want to compare the cost of delivering health care with retina diabetic retinopathy to a coronary bypass to what have you,” he said.

While the quality-adjusted life-year for these treatments is still in the acceptable range for lawmakers, the cost still must be considered, as should treatment burdens for patients, Smiddy said.

Laser or triamcinolone treatments should be considered for patients with better vision, and for pseudophakic patients triamcinolone should also be evaluated, he added.

“We might want to consider bevacizumab for the better baseline visual acuity patients. Might want to consider agents that last longer, or use a treat and extend approach. Might want to consider [panretinal photocoagulation] for example for a younger patient, especially without diabetic macular edema,” he said. “These cost considerations might be at least of some value in factoring in to what we want to do.” – by Rebecca Forand

Reference:

Smiddy W. Cost considerations in management of diabetic retinopathy. Presented at: Retina 2017; Jan. 16-20, 2017; Koloa, Hawaii.

Disclosure: Smiddy reports no relevant financial disclosures.