Economic evaluation of prevention of cystoid macular edema after cataract surgery in nondiabetic patients: ESCRS PREMED study report 4.

Purpose To investigate the cost-effectiveness of prophylactic treatments against cystoid macula edema (CME) after cataract surgery in nondiabetic patients. Setting Seven ophthalmology clinics in the Netherlands and Belgium. Design Prospective cost-effectiveness analysis using data from a European multicenter randomized clinical trial (ESCRS PREMED). Methods Nondiabetic patients planned for expected uncomplicated cataract surgery were randomized to topical bromfenac (Yellox, n=242), topical dexamethasone (n=242), or a combination treatment (n=238). All relevant resources from a healthcare perspective were included in the cost analysis within a time horizon of 12 weeks postoperatively. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) based on the cost per QALY. Results The study comprised 722 nondiabetic patients. Total healthcare costs and QALYs were O 447 (US$ 562) and 0.174 in the bromfenac group, O 421 (US$ 529) and 0.179 in the dexamethasone group, and O 442 (US$ 555) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was O 6544 (US$ 8221) per QALY for the combination group compared to the dexamethasone group. Assuming the willingness-to-pay is O 20,000 (US$ 25,126) per QALY, the cost-effectiveness probability was 3%, 32%, and 65% in the bromfenac, dexamethasone, and combination groups, respectively. Conclusions In nondiabetic patients, combination treatment with topical bromfenac and dexamethasone was effective and cost-effective in preventing CME after cataract surgery, compared to treatment with either drug alone.