A systematic review of the cost-effectiveness of anti-VEGF drugs for the treatment of diabetic retinopathy

Background Non-proliferative and proliferative diabetic retinopathy (DR) are common complications of diabetes and a major cause of sight loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs represent a treatment option for people with DR and are routinely used to treat various other eye conditions. Anti-VEGF drugs are, however, expensive relative to current care options and it is unclear whether this additional cost would be justified in DR, where immediate risks of sight loss are low compared to those for patients with more aggressive ophthalmological conditions. Objective To systematically review the existing evidence supporting the cost-effectiveness of alternative treatments for DR considering a UK decision-making perspective. Methods A systematic review of all comparative cost-effectiveness studies was conducted evaluating any treatment for DR. Included studies were synthesised narratively and evaluated with reference to UK decision-making. Studies were grouped by population, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Results The review identified five studies in the PDR population, all of which examined the cost-effectiveness of anti-VEGF treatments compared to pan-retinal photocoagulation (PRP). Results of these studies suggest that anti-VEGF treatments offer some additional benefits in terms of preserved visual acuity, but also incur substantial additional costs relative to PRP. Most authors expressed reservations about the additional costs outweighing the limited benefits, especially in certain patient subgroups without pre-existing oedema. The majority of the identified evidence considered a US perspective, it is unclear how these results would translate to a UK setting. Two studies were identified in the NDPR population. There was limited evidence to support the early use of anti-VEGF treatment. One UK study, however, suggested that early treatment of NPDR with PRP is cost-effective compared to delayed PRP. Conclusions Overall, there is a dearth of cost-effectiveness evidence considering the UK context. The identified studies raised doubts about the cost-effectiveness of anti-VEGF treatments for PDR. No conclusions can be made regarding the cost-effectiveness of anti-VEGF for NPDR. Future research should focus on developing rigorous model-based cost-effectiveness analyses integrating all available evidence.