First Author: A.Brent UK
Co Author(s): S. Ch'ng V. Konidaris T. Empeslidis S. Banerjee
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It has been hypothesised that using a long acting corticosteroid implant (FAc) in the treatment for DMO, as opposed to the current standard, will reduce the frequency of clinic visits and need for other treatment modalities. Ultimately this may reduce the overall cost burden of treating these patients. Given the recent economic climate of austerity, this cost saving will be welcomed by health authorities across the world. The primary purpose of this study is to look at the real world cost difference to a tertiary NHS hospital between those patients treated with FAc (Iluvien®) versus those who are not.
This study was conducted at the University Hospitals of Leicester (UHL), a tertiary national health service (NHS) centre in the UK.
The inclusion criteria of the study was any patient who had been treated at UHL with FAc for refractory DMO for a minimum period of 12 months. Our study incorporates all costs from that of the drug, to the clinic visits and the costs of treating any associated adverse events or side effects. In particular we have included the cost of any rescue therapy given and the cost of managing intraocular pressure (IOP) rises. Of the patients identified we split them into two groups (A and B). Group A looks at the annual cost for each eye treated (ACFEET) in the years before the patients had the FAc treatment, provided that they were deemed refractory in these years. Group B looks at the ACFEET for the same patients but in the years after the FAc treatment. Effectively our study identifies the cost change when we switched patients from the standard treatment to FAc. We have incorporated a visual acuity (VA) and central retinal thickness (CRT) analysis in order to demonstrate non-inferiority between the groups.
We identified 14 eyes of 13 patients who met the inclusion criteria. If we exclude the management of IOP rises then the FAc group of patients have on average 9 less clinic visits, 7 less intravitreal injections and 3 less laser treatments over 3 years than the standard group. This equates to savings of £752.87, £2746 and £1011.00 respectively. Over 3 years, this represents a saving of £4510.31 when compared to the previous treatment. Our study demonstrated 7 cases (50%) of an intraocular pressure (IOP) rise after FAc implantation that required medical treatment. Two of these cases (14.3%) were not adequately controlled on medical therapy and required glaucoma surgery. The prescribing of glaucoma medications, additional glaucoma clinic appointments and the subsequent glaucoma surgeries inevitably had an implication of the overall cost savings in the FAc group. Despite the need for IOP treatment Group B proved to produce a saving of £4116.76 per patient over 3 years. Our study did not demonstrate and significant differences between the VA and CRT changes over the course of treatment in the two groups.
The authors acknowledge that across different countries and health authorities there will be variability in the costs described based on differing patient demographics and clinician practice. However the authors feel that on balance the use of FAc in refractory DMO patients represents a significant cost saving compared to the standard. In our patient cohort we have demonstrated non-inferiority in terms of treatment efficacy. It can therefore be considered a credible alternative to current practice. With the current austerity measures, particularly in the UK, the authors hope that this study will help encourage clinicians to consider the financial implications of treatments they prescribe and not just the efficacy. A literature search of FAc treatment for DMO and its financial impact on health authorities demonstrated only two relevant references. These two abstracts use estimated costs based on treatment models and extrapolated costs from limited data respectively. Therefore this is the first real world study comparing cost savings demonstrated with FAc treatment for DMO.