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.

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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