Anti-vascular endothelial growth factor drugs compared with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy: a cost-effectiveness analysis

To evaluate the cost-effectiveness of anti-vascular endothelial growth factor drugs (anti-VEGFs) compared with panretinal photocoagulation (PRP) for treating proliferative diabetic retinopathy (PDR) in the UK. A discrete event simulation model was developed, informed by individual patient data meta-analysis. The model captures treatment effects on best corrected visual acuity in both eyes, and the occurrence of diabetic macular oedema (DMO) and vitreous haemorrhage. The model also estimates the value of undertaking further research to resolve decision uncertainty. Anti-VEGFs are unlikely to generate clinically meaningful benefits over PRP. The model predicted anti-VEGFs be more costly and similarly effective to PRP, generating 0.029 fewer QALYs at an additional cost of £3,688, with a net health benefit of -0.214 at a £20,000 willingness-to-pay threshold. Scenario analysis results suggest that only under very select conditions may anti-VEGFs offer potential for cost-effective treatment of PDR. The consequences of loss to follow-up were an important driver of model outcomes. Anti-VEGFs are unlikely to be a cost-effective treatment for early PDR compared to PRP. Anti-VEGFs are generally associated with higher costs and similar health outcomes across various scenarios. Whilst anti-VEGFs were associated with lower DMO rates, the number of cases avoided is insufficient to offset the additional treatment costs. Key uncertainties relate to the long-term comparative effectiveness of anti-VEGFs, particularly considering the real-world rates and consequences of treatment non-adherence. Further research on long-term visual acuity, and rates of vision-threatening complications may be beneficial in resolving uncertainties.