Abstract
Background and objectives
Diabetic macular edema (DME) is a major cause of diabetes-related vision impairment. This study assessed the cost-effectiveness of bevacizumab (Avastin®) and aflibercept (Eylea®) under treat-and-extend (T&E) and pro re nata (PRN) regimens in real-world DME management.
Methods
A field-based retrospective study was conducted at a tertiary eye hospital in Baghdad, Iraq, from October 2024 to March 2025. Clinical data were obtained from medical records, while economic and sociodemographic data were collected through face-to-face interviews. The study included 394 patients with DME: LD Avastin (n = 206), LD Eylea (n = 188), T&E Avastin (n = 139), T&E Eylea (n = 124), PRN Avastin (n = 67), and PRN Eylea (n = 64). Clinical outcomes included best-corrected visual acuity and central macular thickness. Costs and incremental cost-effectiveness ratios (ICERs) were assessed from the payer’s perspective.
Results
During the loading phase, Eylea produced a greater mean utility gain than Avastin (0.0909 ± 0.0117 vs. 0.0221 ± 0.0106; p = 0.0001). During maintenance, both T&E regimens produced greater utility gains than PRN strategies. PRN Avastin had the lowest utility gain (0.0066 ± 0.0072), while PRN Eylea showed modest improvement (0.0278 ± 0.0148; p = 0.0001). Eylea-based regimens exceeded the willingness-to-pay threshold, whereas T&E Avastin remained cost-effective.
Conclusion
T&E Avastin was the most cost-effective strategy for DME, offering economic savings while maintaining effective disease management. These findings may support treatment decisions in resource-limited settings.
| Intend to be published in the IJPS ? | NO |
|---|---|
| Has the manuscript been published | published |
