Quality-Adjusted Life Years in Macular Edema: The Benefit of Anti-VEGF Agents in a Tertiary Center in Greece

Abstract Introduction: Diabetic macular edema (DME), wet age-related macular degeneration (AMD) and macular edema due to central retinal vein occlusion (CRVO) are leading causes of vision loss, currently managed with anti-vascular endothelial growth factor injections (anti-VEGF). Aim of this study was to calculate QALYs in patients with DME, AMD and CRVO treated with anti-VEGF agents (QALYs+) in a Greek tertiary hospital setting and compare them to theoretical QALYs that the patients would have without treatment (QALYs-). Material and Methods: The study included 143 treatment-naive patients with macular edema due to DM (n=57), AMD (n=79) and CRVO (n=7), who received anti-VEGF injections as monotherapy according to the Treat-and-Extend (T&E) protocol. The anti-VEGF agents were ranibizumab and aflibercept in equivalent fractions. QALYs where calculated by the formula QALY = Utility Value * Time, where “time” refers to the follow-up period of the study. For QALYs-, we assumed that visual acuity remained unchanged during this period.Results: Mean follow-up time was 1+1.3 years in the DME group, 1.3 + 1.2 years in the AMD group and 0.5 +1 years in the CRVO group. For patients with DME, QALYs- were 0.75, and QALYs+ were 0.78 (QALY difference +0.033, p=0.439). For patients with AMD, QALYs- were 0.95 and QALYs+ were also 0.95 (QALY difference 0, p=0.45). QALYs- of patients with CRVO were 0.77, and QALYs+ were 0.80 (QALY difference +0.032, p=0.09).Discussion/Conclusion: QALYs+ were identical to QALYs- in patients with AMD and QALYs+ were minimally higher than QALYs- in patients with DME and CRVO in this specific Greek setting for a time horizon between 0.5 and 1.3 years. Possible explanations are the short time horizon used in this analysis and the inclusion of data from the better-seeing eye (BSE).