OBJECTIVES: To understand eye related HCRU and costs over two years in DME patients newly initiating treatment with DEX or aVEGF (ranibizumab-RAN, aflibercept-AFL,bevacizumab-BEV)

METHODS: Retrospective analysis of DME patients using IBM MarketScan database (January 1, 2015 to December 31, 2019). Subjects >18 yo, continuously enrolled >12 months prior and >24 months after treatment initiation, >1 DME diagnosis during pre-index and >1 study treatment at index. Subjects were excluded with >1 pre-index study treatment. DEX and aVEGF were stratified into monotherapy groups as either DEX or branded aVEGF (RAN + AFL) while first combination groups were stratified into either DEX or all aVEGF (RAN + AFL + BEV) groups. Costs and HCRU were assessed over 12 and 24-months using multivariable models controlling for 14 baseline characteristics including total baseline costs.

RESULTS: 2,398 aVEGF (1,914 branded aVEGF mono, 484 all aVEGF-first combo) and 114 (61 mono, 53 first combo) DEX users were included. Controlling for baseline differences, in the monotherapy groups the mean HCRU (95% CI) over 12 months was significantly lower for DEX: 8.05 (6.63 – 9.76), ratio: 0.56 (0.47 – 0.66) compared to branded aVEGF 14.48 (13.17 – 15.94). Mean (95% CI) DME treatment costs were significantly lower for DEX: $2,029 ($1,504 – $2,739) compared to branded aVEGF: $5,727 ($4,891 - $6,707) ratio: 0.35 (0.27 – 0.46).. In the first combination groups DEX was associated with significantly lower HCRU, 13.92 (11.51 - 16.83) and costs $3,108 ($2,276 - $4,244) compared to all aVEGF: HCRU 20.25 (18.21 - 22.51) ratio: 0.69 (0.58 - 0.81) and costs $5,133 ($4,298 - $6,130), ratio: 0.61 (0.30 – 0.81). Trends were similar in year 2.

CONCLUSION: DEX use as initial therapy in DME was associated with significantly lower eye-related HCRU and costs compared to branded aVEGF as monotherapy and all aVEGF first combination in 12 months after initiation of therapy.