Cost-effectiveness analysis of early versus late switching in treatment-naive patients with refractory diabetic macular oedema in the Turkish population: real-world data from the Bosphorus DME study group, report number 5

Karatas, Gamze; Cakir, Akin; Yildiz, Dilan; Arici, Murat; Korkmaz, Anil; Ermis, Serhat; Ciloglu Hayat, Serife; Karapapak, Murat; Ozal, Ece; Ozal, Sadik; Erdogan, Mehmet; Kocak, Ibrahim; Sayin, Nihat; Karabas, Veysel; ÖNDER TOKUÇ, ECEM; Ozturk, Mine; Tiryaki Demir, Semra; Karatas, Mehmet; Ucak, Turgay; Demirayak, Bengi; Onur, İsmail; Hepokur, Mustafa; Ozkaya, Abdullah

doi:10.1080/08164622.2025.2601290

Cost-effectiveness analysis of early versus late switching in treatment-naive patients with refractory diabetic macular oedema in the Turkish population: real-world data from the Bosphorus DME study group, report number 5

Karatas G., Cakir A., Yildiz D., Arici M., Korkmaz A., Ermis S., ...Daha Fazla

CLINICAL AND EXPERIMENTAL OPTOMETRY, cilt.109, sa.5, ss.1062-1071, 2026 (SCI-Expanded, Scopus)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 109 Sayı: 5
Basım Tarihi: 2026
Doi Numarası: 10.1080/08164622.2025.2601290
Dergi Adı: CLINICAL AND EXPERIMENTAL OPTOMETRY
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, MEDLINE
Sayfa Sayıları: ss.1062-1071
Anahtar Kelimeler: Cost-effectiveness, diabetic macular oedema, early switching, multicentre, real-world data
İstanbul Üniversitesi Adresli: Evet

Özet

Clinical relevance: Diabetic macular oedema (DME) is a leading cause of visual impairment worldwide. Real-world evidence is essential for understanding treatment effectiveness and guiding practical decision-making in routine clinical care. Background: The aim of this work is to evaluate the cost-effectiveness of early versus late switching to intravitreal aflibercept or ranibizumab in eyes with DME refractory to intravitreal bevacizumab loading treatment. Methods: This multicentre retrospective study included treatment-na & iuml;ve refractory DME eyes that initiated bevacizumab between 2021 and 2023. Eyes were divided into three groups: no switch, early switch (3-6 months), and late switch (after 6 months). Public healthcare costs from 2021-2023 were used to calculate the cost per 0.1 improvement in best-corrected visual acuity (BCVA) and per 100 mu m reduction in central macular thickness. Cost-effectiveness ratio and incremental cost-effectiveness ratio analyses were performed. Results: A total of 229 eyes in the no-switch group, 328 eyes in the early-switch group, and 63 eyes in the late-switch group were analysed. At month 12, the greatest BCVA gain was observed in the early-switch group (p = 0.02). Mean injection numbers were 5.7 +/- 1.4 (no-switch), 7.2 +/- 1.5 (early-switch), and 6.6 +/- 1.4 (late-switch) (p < 0.001). Cost-effectiveness ratio for visual acuity improvement was 4,838, 10,395, and 10,848 for the no-switch, early-switch, and late-switch groups, respectively. Incremental cost-effectiveness ratio analysis showed additional costs of 15,654 for early switching and 54,856 for late switching compared with no switching. Central macular thickness reduction was greatest in the no-switch group and lowest in the late-switch group (p = 0.05). Conclusion: Although early switching yields the greatest visual improvement and faster rehabilitation, it incurs higher costs. The no-switch strategy provided modest visual improvement at the lowest cost, resulting in the most favourable cost-effectiveness ratio. Late switching produced limited benefit at high cost, rendering it an unfavourable option. Treatment decisions should balance clinical efficacy and cost-effectiveness on an individual basis.