Archana Nair, MD MS
Vanderbilt Eye Institute
The final day of presentations from ASRS featured a new set of exciting lectures. In the Diabetic Retinopathy session, moderated by Francesco Boscia and Jennifer Sun, Dr. Paul Hahn from NJ retina presented his work titled Benefits and Value of Treatment for Macular Edema.
This remarkable work used a microsimulation model using the DRCR clinical data to create an economic model of the visual acuity benefits, direct benefits, and indirect benefits of treating DME using standardized treatments. Direct benefits included mortality and quality of life and indirect benefits included disability cost and loss of employment. These outcomes were modeled for patients who had received no treatment, laser, anti-VEGF, and steroids. This data was then scaled to calculate representative societal benefits using the 2020 Vestrum health database to assess the overall economic value of treatment.
Dr. Hahn ran the simulation for a 51-year-old with DME. For a patient of that age, anti-VEGF therapy was predicted to have 5.4 additional years (35%) of good vision. This correlated in the model to have a 5% improvement in life expectancy years and 14% improvement in quality adjusted life years (QALY). The indirect effects were equally striking with a 9% improvement in years working, 19% improvement in total earnings, 13% improvement in disability free years, and a 17% decrease in disability benefits received. Smaller benefits of treatment were also noted with laser and steroid treatment compared to observation.
Treatment benefits of anti-VEGF therapy for DME were compared against the economic benefits for common chronic diseases such as high blood pressure, heart failure, and diabetes. Anti-VEGF therapy for DME was found to have similar improvements in QALY, disability years, and life expectancy gains as treating these common chronic conditions as well as treating some oncological disorders with immune directed therapies.
Overall, the model predicted that treating DME constitutes an early net loss of value in the first 2 years, but this becomes a large societal value at the 20-year mark with an estimated net value of $47.8 billion indirect and direct benefit with real world data and $52.8 billion based on DRCR data.
Dr. Paul Hahns work highlights the overall economic impact that retinal physicians provide to society. As our field continues to advocate at a national level for reimbursements, work like this helps demonstrate the true value of injections and legislate for fair reimbursements.