Diabetic Eye Drug Implant Not Most Cost-Effective First-Line Treatment

Ocular Coherence Topography (OCT) demonstrating Diabetic Macular Edema. (DME) is an accumulation of fluid in the macula part of the retina that controls our most detailed vision abilities due to leaking blood vessels. In order to develop DME, you must first have diabetic retinopathy.
Although the dexamethasone implant is effective, intravitreal injections are more cost-effective as a first approach.

A dexamethasone implant may be a cost-effective treatment for resistant diabetic macular edema (DME), according to findings published in Acta Ophthalmologica, but not for first-line therapy, the study shows.

The retrospective, single-center study was conducted at the Oslo University Hospital in Norway. Data on all intravitreal injections performed between 2017 and 2018 were evaluated for indication (first-line therapy or resistant DME) and treatment frequency for 1 year. National fee schedules for dexamethasone and listed drug prices were assessed in a cost-evaluation analysis.

In 2017, 70 patients were naïve to treatment and 28 were switching therapies. Among the naïve cohort, 50% of patients using bevacizumab for 1 year received an average of 8.3 injections throughout the year, every 44 days. The other half of patients switched to aflibercept (48.6%) or ranibizumab (1.4%). The patients with resistant DME who switched to aflibercept received a mean total of 9.1 injections every 43 days on average.

The cost of bevacizumab among the naïve cohort — in Euros — was €1114 per year. For dexamethasone it was €3061. Including drug cost, transport cost, and patient time, bevacizumab was more cost effective than dexamethasone from the health care perspective (€3619 vs €4252). Bevacizumab was also more cost effective from the extended health care perspective which considers the dexamethasone treatment protocol, which requires fewer injections (€4987 vs €5116).

For the treatment of resistant disease, aflibercept cost €2824 per year. Total cost from the health care perspective favored dexamethasone (€5226 vs €4252) as did the extended health care perspective (€6537 vs €5116).

In a sensitivity analysis which considered the upper and lower bounds of the number of injections received, bevacizumab remained favored over dexamethasone among the treatment naïve group, with a greater difference in cost with fewer injections received (difference, lower bound: €1173 vs upper bound: €92). For the resistant group, dexamethasone remained favored to aflibercept, with a greater difference in cost with more injections received (difference, lower bound: €−472 vs upper bound: €−1476).

This study may have been limited by combining real-world patient use schedules with published use schedules.

This study found that the most cost-effective intravitreal treatment for DME was bevacizumab for treating naïve patients and dexamethasone for patients switching due to nonresponse.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Hertzberg SNW, Moe MC, Jørstad ØK, Petrovski BÉ, Burger E, Petrovski G. Healthcare expenditure of intravitreal anti-vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema. Acta Ophthalmol. Published online April 25, 2022. doi:10.1111/aos.15151