OBJECTIVES:  comparative pharmacoeconomics of combined anti-VEGF/laser treatment of diabetic macular edema (DME) with a variety of clinical parameters. METHODS: comparative retrospective cost-utility analysis (CUA) of 55 patients with DME due to diabetes type 2 (D2T) treated with combination of ranibizumab injections and laser photocoagulation. Laser was done differently according to current indications for every case. Due to financial/logistic limitations patients were retrospectively divided into two main groups: predominantly laser treatment with 2 or less injections (“2-“ group) and predominantly ranibizumab “3+” injections group. QALY gain after 1 year treatment was defined with EQ-5D questionnaire. Direct medical expenses were calculated according to current Russian Federal health care diagnostic/treatment standards. Willingness-to-pay threshold (WTP) of 3 GDP per capita was equivalent 32595 Euro. CUA was done with respect to the number of ranibizumab injections, number of laser coagulations and different clinical parameters: age, gender, diabetic retinopathy type, insulin therapy, blood pressure, glycaemia, and HbA1c level. RESULTS: In group “2-“ QALY gain was negative, therefore QALY cost -116310 Euro. QALY change in group “3+” was 0,09 and cost 31742 Euro (below WTP). With respect to defferent clinical parameters, better cost-effectiveness ratio was obtained: 1) when combined treatment included 3 or more injections and 2 or less lasercoagulations; 2) for patients of 51 to 70 y.o.; 3) with non-proliferative diabetic retinopathy; 4) without insulin therapy; 5) witn normal blood pressure; 6) with HbA1c equal/lower 7%. CONCLUSIONS: Combined anti-VEGF/laser treatment of patients with 3+ injections of ranibizumab is economically feasible because significant QoL improvement compensates higher direct cost of treatment. Fewer injections scenario, although cheaper, was ineffective due to worse QoL gain. The cost-effectiveness of the treatment also depends on many parameters – diabetic retinopathy type, illness duration, insulin therapy, age and gender. More research is needed to define the most cost-effective treatment scenario.