Abstract:
IMPORTANCE:Anti-vascular endothelial growth factor (VEGF) medicines have revolutionized diabetic macular edema (DME) treatment. A recent randomized clinical trial comparing anti-VEGF agents for patients with decreased vision from DME found that at 1 year aflibercept (2.0 mg) achieved better visual outcomes than repackaged (compounded) bevacizumab (1.25 mg) or ranibizumab (0.3 mg); the worse the starting vision, the greater the treatment benefit with aflibercept. However, aflibercept and ranibizumab, respectively, are approximately 31 and 20 times more expensive than bevacizumab. OBJECTIVE:To examine the incremental cost-effectiveness ratios (ICERs) of aflibercept, bevacizumab, and ranibizumab for the treatment of DME. DESIGN, SETTING, AND PARTICIPANTS:Post hoc analysis of efficacy, safety, and resource utilization data at 1-year follow-up from the Diabetic Retinopathy Clinical Research Network Comparative Effectiveness Trial. Patients were enrolled from August 22, 2012, through August 28, 2013, and analysis was performed from August 21, 2014, through November 7, 2015. MAIN OUTCOMES AND MEASURES:The ICERs for all trial participants and subgroups with baseline vision of approximate Snellen equivalent 20/32 to 20/40 (better vision) and baseline vision of approximate Snellen equivalent 20/50 or worse (worse vision). One-year trial data were used to calculate cost-effectiveness for 1 year for the 3 anti-VEGF agents; mathematical modeling was then used to project 10-year cost-effectiveness results. RESULTS:The study included 624 participants (mean [SD] age, 60.6 [10.5] years; 45.7% female; 65.5% white), 209 in the aflibercept group, 207 in the bevacizumab group, and 208 in the ranibizumab group. For all participants, during 1 year, the ICERs of aflibercept and ranibizumab compared with bevacizumab were $1 110 000 per quality-adjusted life-year (QALY) and $1 730 000 per QALY, respectively. During 10 years, they were $349 000 per QALY and $603 000 per QALY, respectively. Compared with ranibizumab, aflibercept's ICER was $648 000 per QALY at 1 year and $203 000 per QALY at 10 years. For the subgroup with worse baseline vision, the 10-year ICERs of aflibercept and ranibizumab compared with bevacizumab were $287 000 per QALY and $817 000 per QALY, respectively. In eyes with decreased vision from DME, treatment costs of aflibercept and ranibizumab would need to decrease by 69% and 80%, respectively, to reach a cost-effectiveness threshold of $100 000 per QALY compared with bevacizumab during a 10-year horizon; for the subgroup with worse baseline vision, the costs would need to decrease by 62% and 84%, respectively. CONCLUSIONS AND RELEVANCE:Aflibercept (2.0 mg) and ranibizumab (0.3 mg) are not cost-effective relative to bevacizumab for treatment of DME unless their prices decrease substantially. These results highlight the challenges that physicians, patients, and policymakers face when safety and efficacy results are at odds with cost-effectiveness results.
journal_name
JAMA Ophthalmoljournal_title
JAMA ophthalmologyauthors
Ross EL,Hutton DW,Stein JD,Bressler NM,Jampol LM,Glassman AR,Diabetic Retinopathy Clinical Research Network.doi
10.1001/jamaophthalmol.2016.1669subject
Has Abstractpub_date
2016-08-01 00:00:00pages
888-96issue
8eissn
2168-6165issn
2168-6173pii
2527104journal_volume
134pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To investigate the efficacy of WINROP (https://winrop.com), an algorithm based on serial measurements of neonatal body weight to predict proliferative retinopathy of prematurity (ROP), in a Korean population of preterm infants. METHODS:The records of preterm infants with gestational age less than 32 weeks wh...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2013.566
更新日期:2013-01-01 00:00:00
abstract:IMPORTANCE:Visualization and interpretation of the optic nerve and retina are essential parts of most physical examinations. OBJECTIVE:To design and validate a smartphone-based retinal adapter enabling image capture and remote grading of the retina. DESIGN, SETTING, AND PARTICIPANTS:This validation study compared the...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2015.4625
更新日期:2016-02-01 00:00:00
abstract:Objective:To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design, Setting, and Participants:The Mycotic Ulcer Treatment Trial II (MUTT II), a multicenter, double-masked, placebo-controlled, randomized clinical trial, was conducted in India ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaophthalmol.2016.4096
更新日期:2016-12-01 00:00:00
abstract:Importance:Both primary and secondary forms of childhood glaucoma have many distinct causative mechanisms, and in many cases a cause is not immediately clear. The broad phenotypic spectrum of secondary glaucoma, particularly in individuals with variants in FOXC1 or PITX2 genes associated with Axenfeld-Rieger syndrome, ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2018.5646
更新日期:2019-04-01 00:00:00
abstract:Importance:Examining costs and consequences of different low-vision (LV) programs provides important information about resources needed to expand treatment options efficiently. Objective:To examine the costs and consequences of LV rehabilitation or basic LV services. Design, Setting, and Participants:The US Departmen...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaophthalmol.2018.0797
更新日期:2018-05-01 00:00:00
abstract:IMPORTANCE:Superior rectus transposition (SRT) with or without medial rectus recession (MRc) has been introduced as an alternative to MRc alone for treatment of esotropic Duane syndrome; however, the effectiveness of these procedures has not been compared previously. OBJECTIVE:To compare the safety and efficacy of MRc...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2014.358
更新日期:2014-06-01 00:00:00
abstract:Importance:Mutations in the myocilin (MYOC) gene are the most common molecularly defined cause of primary open-angle glaucoma that typically occurs in patients with high intraocular pressures (IOP). One MYOC mutation, p.Gln368Ter, has been associated with as many as 1.6% of primary open-angle glaucoma cases that had a ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2019.0005
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study. DESIGN:Prospective, interventional, multicenter follow-up of a randomized clinical trial. METHODS:Patients who agreed to participate bet...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/2013.jamaophthalmol.91
更新日期:2013-02-01 00:00:00
abstract:Importance:Congenital stationary night blindness (CSNB) implies a stable condition, with the major symptom being nyctalopia present at birth. Pediatric clinical presentation and the course of different genetic subtypes of CSNB have not, to our knowledge, been well described in the era of molecular genetic diagnosis. O...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2018.0185
更新日期:2018-04-01 00:00:00
abstract:Importance:Although the association between suture colonization and postoperative infections remains hypothetical, measures to reduce perioperative suture colonization may minimize postoperative infections. The suture colonization rate in adjustable suture strabismus surgery is not well defined, and the effect of povid...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaophthalmol.2016.2926
更新日期:2016-10-01 00:00:00
abstract:IMPORTANCE:Anterior chamber seeding following intraophthalmic artery chemotherapy is rarely reported. OBJECTIVES:To describe clinicopathologic observations in eyes in which intraophthalmic artery chemotherapy for retinoblastoma failed and to report anterior chamber involvement. OBSERVATIONS:A retrospective case serie...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2015.2861
更新日期:2015-12-01 00:00:00
abstract:IMPORTANCE:Swedish Interactive Thresholding Algorithm (SITA) testing strategies for the Humphrey Field Analyzer have become a clinical standard. Measurements from SITA Fast are thought to be more variable than SITA Standard, yet some clinics routinely use SITA Fast because it is quicker. OBJECTIVE:To examine the measu...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaophthalmol.2014.4237
更新日期:2015-01-01 00:00:00
abstract:IMPORTANCE:We describe a sign that can be used as a rapid and noninvasive adjunct to aid in the diagnosis of foveal hypoplasia. OBJECTIVE:To describe a concentric macular rings sign found on infrared reflectance (IRR) images in patients with foveal hypoplasia. DESIGN, SETTING, AND PATIENTS:We studied 13 patients with...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2014.1715
更新日期:2014-09-01 00:00:00
abstract:IMPORTANCE:Few studies have been published on the association of the radiation dose received to the eyes during radiotherapy (RT) for childhood cancer and the risk for later cataract. OBJECTIVE:To investigate the risk for cataract after treatment of nonretinoblastoma solid cancer in childhood. DESIGN, SETTING, AND PA...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2015.6088
更新日期:2016-04-01 00:00:00
abstract:Importance:Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients. Objective:To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP co...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.5892
更新日期:2021-01-14 00:00:00
abstract:IMPORTANCE:Myopia (nearsightedness) has its onset in childhood and affects about one-third of adults in the United States. Along with its high prevalence, myopia is expensive to correct and is associated with ocular diseases that include glaucoma and retinal detachment. OBJECTIVE:To determine the best set of predictor...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaophthalmol.2015.0471
更新日期:2015-06-01 00:00:00
abstract:Importance:To our knowledge, a set of well-defined diagnostic criteria is not yet developed for the diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Objective:To develop and evaluate a set of diagnostic criteria for VKH disease using data from Chinese patients. Design, Setting, and Participants:This case-control stud...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2018.2664
更新日期:2018-09-01 00:00:00
abstract:Importance:The comparative clinical effectiveness of ranibizumab, aflibercept, and bevacizumab for the management of macular edema due to central retinal vein occlusion (CRVO) is unclear. Objective:To determine whether intravitreal aflibercept or bevacizumab compared with ranibizumab results in a noninferior mean chan...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2019.3305
更新日期:2019-08-29 00:00:00
abstract::IMPORTANCE Advanced glycation end products have been implicated in the pathogenesis of age-related macular degeneration (AMD). OBJECTIVE To investigate the relationship between serum carboxymethyllysine (CML), a major circulating advanced glycation end product, and AMD in older adults. DESIGN, SETTING, AND PARTICIPANT...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2013.7664
更新日期:2014-04-01 00:00:00
abstract:IMPORTANCE:The Standard of Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study showed that intravitreal triamcinolone acetonide (IVTA) is effective at reducing macular edema and improving visual acuity in participants with retinal vein occlusion. Secondary analysis of the incidence, risk factors, and timing...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaophthalmol.2015.1823
更新日期:2015-09-01 00:00:00
abstract:IMPORTANCE:Descemet stripping automated endothelial keratoplasty (DSAEK) for isolated endothelial dysfunction has become the preferred surgical option for many corneal surgeons. However, there are limited large-scale reports on DSAEK survival and clinical variables affecting the risk of rejection and failure after fail...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaophthalmol.2014.352
更新日期:2014-06-01 00:00:00
abstract:Importance:Diabetic retinopathy (DR) is a devastating complication of individuals with type 2 diabetes mellitus. The retina is rich in long-chain ω-3 polyunsaturated fatty acids (LCω3PUFAs), which are substrate for oxylipins with anti-inflammatory and antiangiogenic properties. Experimental models support dietary LCω3P...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaophthalmol.2016.2906
更新日期:2016-10-01 00:00:00
abstract:Importance:The number and size of guttae increase over time in Fuchs endothelial corneal dystrophy (FECD); however, the association between these physical parameters and disease pathogenesis is unclear. Objective:To determine the role of guttae in corneal endothelial cell function. Design, Settings, and Participants:...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2018.2031
更新日期:2018-08-01 00:00:00
abstract:IMPORTANCE:The presence of choroidal hyperreflective foci in Stargardt disease is, to our knowledge, a potentially new finding. Evaluation of these foci may aid in better understanding of the disease process. OBJECTIVES:To report the presence of choroidal hyperreflective foci in spectral-domain optical coherence tomog...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2014.5604
更新日期:2015-04-01 00:00:00
abstract:Importance:After long-duration spaceflight, morphological changes in the optic nerve head (ONH) and surrounding tissues have been reported. Objective:To develop methods to quantify ONH and surrounding tissue changes using preflight and postflight optical coherence tomographic scans of the ONH region. Design, Setting,...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2017.6226
更新日期:2018-02-01 00:00:00
abstract:IMPORTANCE:To facilitate comparative clinical outcome research in low vision rehabilitation, we must use patient-centered measurements that reflect clinically meaningful changes in visual ability. OBJECTIVE:To quantify the effects of currently provided low vision rehabilitation (LVR) on patients who present for outpat...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaophthalmol.2015.0693
更新日期:2015-07-01 00:00:00
abstract:Importance:Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also infect tissues besides the respiratory system, such as the ocular tissues, remains unclear. Objective:To determine whether SAR...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.3962
更新日期:2020-10-08 00:00:00
abstract:Importance:Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated. Objectives:To evaluate the repeatability of visual acuity m...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.5972
更新日期:2021-01-07 00:00:00
abstract:Importance:The ocular surface is continuously exposed to the environment. Although studies have focused on associations between outdoor environmental conditions and dry eye, information on associations between the indoor environment and dry eye is lacking. Objective:To determine associations between the indoor environ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.2237
更新日期:2020-08-01 00:00:00
abstract:IMPORTANCE:Orbital lymphangiomas, congenital hamartomas of the lymphovascular tissue, are often associated with significant ocular complications and can be challenging to treat. To date, therapeutic approaches have demonstrated variable results and have significant ocular and systemic risks. We present 2 cases of pedia...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2013.4201
更新日期:2013-09-01 00:00:00