To assess the cost-effectiveness of the delayed-release device of dexamethasone compared with aflibercept in the treatment of patients with naïve diabetic macular edema (DME) from a societal ...perspective in the healthcare sector Zaragoza III in Spain.
A Markov model with five states defined by visual acuity (VA) in the better-seeing eye (Snellen scale) and an additional death state were constructed. Two cohorts of patients were distributed along the VA states and treated during a year with either dexamethasone or aflibercept. One-year follow-up on each group was performed. Medical costs related to the DME treatment and follow-up, medical costs related to the DME comorbidities, and non-medical-related costs were taken into account. Costs (2020 €), health outcomes (Quality-Adjusted Life Years-QALYs), both discounted at a 3.5% annual rate, and incremental cost-effectiveness ratios (ICER: €/QALY) were determined for a lifetime horizon in the base case analysis.
Patients treated with dexamethasone were €77,349 more costly and provided 2.667 additional QALYs (€29,002/QALY) than those treated with aflibercept. The variable efficiency per patient was calculated dividing the improvement in quality of life (on the VFQ-25 scale) by the cost of the treatment. With the obtained results it can be concluded that the efficiency of treating the patients with dexamethasone is significantly superior than the efficiency of treating them with aflibercept.
The cost per QALY gained with the delayed-release device of dexamethasone compared with the one obtained by aflibercept in the naïve DME population is just below the €30,000 threshold, below which, new drugs are sometimes regarded as cost-effective strategies in Spain. In this model, the key variables with greater impact on the cost-effectiveness results were the selected time horizon, the chosen extrapolation method and the number of aflibercept and dexamethasone injections.
Purpose
Sclerochoroidal calcification (SCC) is an unusual and poorly recognized ocular condition which is usually presented as an incidental finding in asymptomatic individuals. An exhaustive ...diagnosis is required as it may be commonly misdiagnosed such as choroidal osteoma, choroidal metastasis, amelanotic choroidal nevus, or lymphoma. It is commonly idiopathic but ophthalmologists should be aware of the possible association with severe ocular trauma and chronic intraocular inflammation, or with abnormal calcium‐phosphorus metabolism
Methods
We report the case of a 78‐year‐old woman with a medical history of breast cancer treated with quadrantectomy followed by adjuvant chemotherapy and radiotherapy, and Letrozole (aromatase inhibitors) for 3 years, which was discontinued when a hypercalcaemia and primary hyperparathyroidism (PHPT) related to a parathyroid adenoma. Oncological follow‐up was negative until during a routine examination prior to a right eye cataract intervention, dilated fundus examination revealed bilateral multiple asymptomatic yellow placoid lesions
Results
The patient's best‐corrected visual acuity (BCVA) was 20/20 in the right and left eye. Tomography–computed tomography (OCT‐scan), Magnetic resonance imaging (MRI) and Positron emission tomography–computed tomography (18‐FDG PET‐TC) revealed diffuse calcification in the choroid plexus bilaterally as well as calcification in the posterior aspect of both globes with no changes in metabolism at these levels. A SCC secondary to hypercalcaemia and PHPT related to a parathyroid adenoma was diagnosed. She was referred to endocrinology specialist to rule out systemic conditions. As the patient stills refusing surgery, she was treated with Cinacalcet (a calcimimetic) with regular follow‐up in the endocrinology clinic. Dilated fundus examination and OCT are performed periodically. For the time being, the patient remains asymptomatic and the lesion stays stable.
Conclusions
All patients with SCC should be tested for underlying systemic disorders involving abnormal calcium‐phosphorus metabolism to avoid complication or unwarranted intervention resulting from the misdiagnosed as a malignant tumor. Periodic ophthalmology studies are required as well to rule out possible complications.
Circumscribed choroidal hemangioma (CCH) is a rare congenital ocular tumor type that is usually benign and asymptomatic. CCH has only been reported once previously in the literature in association ...with a visceral neoplasm. Here, we present a newly described association between CCH and hepatic hemangioma (HH). We report the case of a 57-year-old woman diagnosed with asymptomatic HHs who presented with a 2- to 3-month history of central scotoma and blurred vision in her left eye. Assessment identified an orange-red elevated lesion with a central serous retinal detachment and subretinal edema. Complementary tests suggested a CCH. To our knowledge, CCH has only been reported once previously in association with a visceral neoplasm, making this newly described association between CCH and HH of clinical relevance. Ophthalmologists should be aware of the possible association between CCH and other visceral tumors as this association offers an opportunity for the early detection of this pathology.
Purpose: To assess the clinical course, structural changes, and choroidal neovascularization detection by SS-OCTA in long-standing and resolved patients with chronic central serous chorioretinopathy ...(cCSC) after successful half-fluence photodynamic therapy (hf-PDT) treatment. Methods: Twenty-four eyes presenting with cCSC were examined with SS-OCTA and were classified as choroidal neovascular (CNV) or non-choroidal neovascular (non-CNV) cCSC depending on the vascular pattern detected by SS-OCTA after one, two, and three years after hf-PDT. Two groups were compared based on the following clinical findings: demographic characteristics, time of clinical signs, best corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CFT), subretinal fluid (SRF), flat, irregular pigment epithelial detachment (FIPED), and features of fluorescein angiography (FA) and vascular pattern by SS-OCTA. Results: All patients showed resolved cCSC during follow-up after hf-PDT. A total of 5 of 24 (20.8%) eyes showed a neovascular pattern by SS-OCTA. No differences between BCVA, CRT, SRF, FIPED, or FA features were found between both groups (p > 0.05). However, CFT and older age were associated with a neovascular pattern by SS-OCTA (p < 0.05) in follow-up. No signs of neovascular activity were detected by SS-OCT during follow-up in CNV cCSC patients, and no antiVEGF treatment was required for three-year follow-ups. Conclusions: Despite patients with cCSC showing a favorable clinical response after hf-PDT, lower foveal thickness and older age were associated with CNV patterns by SS-OCTA during follow-up.
Purpose
To assess the suitability of machine learning (ML) techniques in predicting the development of fibrosis and atrophy in patients with neovascular age‐related macular degeneration (nAMD), ...receiving anti‐VEGF treatment over a 36‐month period.
Methods
An extensive analysis was conducted on the use of ML to predict fibrosis and atrophy development on nAMD patients at 36 months from start of anti‐VEGF treatment, using only data from the first 12 months. We use data collected according to real‐world practice, which includes clinical and genetic factors.
Results
The ML analysis consistently identified ETDRS as a relevant factor for predicting the development of atrophy and fibrosis, confirming previous statistical analyses. Also, it was shown that genetic variables did not demonstrate statistical relevance in the prediction. Despite the complexity of predicting macular degeneration, our model was able to obtain a balance accuracy of 63% and an AUC of 0.72 when predicting the development of atrophy or fibrosis at 36 months.
Conclusion
This study demonstrates the potential of ML techniques in predicting the development of fibrosis and atrophy in nAMD patients receiving long‐term anti‐VEGF treatment. The findings highlight the importance of clinical factors, particularly ETDRS (early treatment diabetic retinopathy study) visual acuity test, in predicting these outcomes. The lessons learned from this research can guide future ML‐based prediction tasks in the field of ophthalmology and contribute to the design of data collection processes.
Background
To study the visual outcomes of neovascular AMD (nAMD) treated with anti‐vascular endothelial growth factor (VEGF) drugs at national level.
Methods
Multicenter national database of nAMD ...eyes treated with anti‐VEGF intravitreal injections (ranibizumab, aflibercept, bevacizumab) in fixed bimonthly (FB) or treat‐and‐extend (TAE) regimens. Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) ETDRS letters at baseline and subsequent visits, number of injections and visits data were collected using a validated web‐based tool (Fight Retinal Blindness!).
Results
1273 eyes (1014 patients) were included, 971 treatment naïve (TN) and 302 previously treated (PT). Baseline VA (mean ± SD) was 57.5 (±19.5) and 62.2 (±17) (p > 0.001), and 24 months final VA was 60.4 (±21.2) and 58.8 (±21.1) (p = 0.326), respectively. Mean VA change at 12/24 months was +4.2/+2.9 letters in TN eyes and +0.1/−3.4 letters in PT eyes (p < 0.001/p < 0.001). The percentage of ≥15 letters gainers/losers at 24 months was 24.8%/14.5% in TN, and 10.3%/15.7% in PT eyes. The median number of injections/visits at 12 months was 7/9 in TN and 6/8 in PT (p = 0.002/p < 0.001) and at 24 months was 11/16 in TN and 11/14 in PT (p = 0.329/p < 0.001). Study drugs included ranibizumab (39.5%), aflibercept (41.2%) and bevacizumab (19.3%).
Conclusion
Independent, large‐scale national audits are feasible if committed health care professionals are provided with efficient information technology systems to do them. The results described here represent an adequate measurement of the quality of care delivered nationwide and benchmark the clinical management of nAMD at a country level compared to other real‐world international cohorts.
To evaluate the influence of macular neovascularization (MNV) lesion type on 12-month clinical outcomes in treatment-naive eyes with neovascular age-related macular degeneration (nAMD) treated with ...anti-VEGF drugs nationwide.
Multicenter national nAMD database observational study.
One thousand six hundred six treatment-naive nAMD eyes (1330 patients) undergoing anti-VEGF therapy for 12 months nationwide.
Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution letters, number of injections and visits were was collected using a validated web-based tool. Neovascular lesion phenotype was classified as type 1 (T1, n = 711), type 2 (T2, n = 505), type 3 (T3, n = 315), and aneurysmal type 1 (A-T1, n = 75), according to the new proposed consensus classification.
Mean VA change at 12 months, final VA at 12 months, number of injections, time to lesion inactivation.
A total of 1606 treatment-naive nAMD eyes (1330 patients) received a median of 7 injections over 12 months. Mean (± standard deviation) baseline VA was significantly lower for T2 (49.4 ± 23.5 letters) compared with T1 (57.8 ± 20.8) and T3 (58.2 ± 19.4) (both P < 0.05) lesions. Mean VA change at 12 months was significantly greater for A-T1 (+9.5 letters) compared with T3 (+3.1 letters, P < 0.05). Patients with T3 lesions had fewer active visits (24.9%) than those with other lesion types (T1, 30.5%; T2, 32.6%; A-T1, 27.5%; all P < 0.05). Aflibercept was the most used drug in A-T1 lesions (70.1%) and ranibizumab in T1 (40.7%), T2 (57.7%), and T3 (47.6%) lesions.
This study highlights the relevance of MNV type on clinical outcomes in nAMD and reports significant differences in baseline VA, VA change, and lesion activity at 12 months. This report provides data about lesion-specific clinical features, which may guide the management of nAMD cases and potentially support personalized clinical decision making for these patients.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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