OBJECTIVES

: The fluocinolone acetonide 0.2 μg/day implant (FAc) is effective in improving visual acuity in patients with chronic diabetic macular oedema (cDMO) but is associated with worsening of cataract. A model previously suggested that FAc is cost-effective in patients with cDMO, who have undergone cataract surgery or not. The aim of this study was to update this model and assess the cost-effectiveness of FAc in the subgroup of patients with symptomatic cataract.

METHODS

: The existing Markov model was designed to assess costs and QALYs over lifetime in patients treated with FAc implant, compared to usual care (UC), consisting of laser photocoagulation and anti-VEGFs from the UK NHS perspective. Unit costs and health state utility values (HSUVs) were updated. The FAc price was NHS list price. HSUVs were obtained from the FAME trial using the VFQ-UI utility index. Best-Corrected Visual Acuity (BCVA) with UC was supposed to be stable. Additional scenarios were considered, with BCVA decreasing over time in UC arm, according to real-world data, and with possibility of administering FAc after cataract surgery in the UC arm.

RESULTS

: New HSUVs ranged from 0.48 for blind patients to 0.91 for patients with perfect vision in both eyes. The FAc strategy was more expensive compared to usual care, by £3,445 per patients over lifetime, and produced more QALYs (+0.247). The incremental cost-effectiveness ratio (ICER) was estimated at £13,932 per QALY gained. The ICER was sensitive to the baseline visual acuity, patients’ age and the probability of cataract surgery. The probability of FAc being cost-effective was 66.1% at a threshold of £20,000 per QALY gained. Scenario analyses showed that the efficacy of UC had a strong influence on results, and ICER decreased to £1,686 per QALY gained when BCVA decreased under UC

CONCLUSIONS

: The FAc implant is a cost-effective treatment for cDMO in patients with symptomatic cataract.