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Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion.

Bradshaw SE, Gala S, Nanavaty M, Shah A, Mwamburi M, Kefalas P - BMC Ophthalmol (2016)

Bottom Line: Most treatments did not improve visual acuity significantly.There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden.There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

View Article: PubMed Central - PubMed

Affiliation: Valid Insight®, Kemp House, 152 City Road, London, EC1V 2NX, UK. sbradshaw@validinsight.com.

ABSTRACT

Background: To understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).

Methods: We conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.

Results: A total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.

Conclusions: There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

No MeSH data available.


Related in: MedlinePlus

Incremental cost-effectiveness ratio (ICER) values grouped by cost component. Amounts are in 2015 GBP
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Fig2: Incremental cost-effectiveness ratio (ICER) values grouped by cost component. Amounts are in 2015 GBP

Mentions: Cost components included across all analyses also varied to some extent. All economic studies considered only direct costs or components of direct costs. For example, two studies included cost of treatment and its administration in their analysis [29, 31], whereas four included costs associated with adverse events in their analysis [30, 31, 33, 35]. Since most therapies are associated with complications, cost models cannot be considered robust with consideration of cost of these complications and adverse events. Moreover, none of the studies evaluated indirect costs of complications of iCRVO. Since iCRVO can lead to severe vision loss, it can be assumed that the indirect cost burden will be high. Commonly, observation or no treatment was considered as the comparator. We found only two analyses making direct comparison between active treatments. These were for aflibercept versus ranibizumab and for ranibizumab versus dexamethasone intravitreal implants [29, 31]. Figure 2 shows the ICER values reported across studies with monetary findings converted to 2015 GBP values and grouped by cost components considered in the analysis. All but one of the ICER values are below the accepted £30,000/QALY threshold [43]. Although these therapies stay under the ICER threshold, it is important to note that they are not curative treatments and they only ameliorate the symptoms of the disease. However, the low ICER values are a reflection of significant impacts on quality of life and/or QALYs. Thus, further research is needed in this population to further understand both the clinical effects and the quality-of-life aspects.Fig. 2


Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion.

Bradshaw SE, Gala S, Nanavaty M, Shah A, Mwamburi M, Kefalas P - BMC Ophthalmol (2016)

Incremental cost-effectiveness ratio (ICER) values grouped by cost component. Amounts are in 2015 GBP
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940864&req=5

Fig2: Incremental cost-effectiveness ratio (ICER) values grouped by cost component. Amounts are in 2015 GBP
Mentions: Cost components included across all analyses also varied to some extent. All economic studies considered only direct costs or components of direct costs. For example, two studies included cost of treatment and its administration in their analysis [29, 31], whereas four included costs associated with adverse events in their analysis [30, 31, 33, 35]. Since most therapies are associated with complications, cost models cannot be considered robust with consideration of cost of these complications and adverse events. Moreover, none of the studies evaluated indirect costs of complications of iCRVO. Since iCRVO can lead to severe vision loss, it can be assumed that the indirect cost burden will be high. Commonly, observation or no treatment was considered as the comparator. We found only two analyses making direct comparison between active treatments. These were for aflibercept versus ranibizumab and for ranibizumab versus dexamethasone intravitreal implants [29, 31]. Figure 2 shows the ICER values reported across studies with monetary findings converted to 2015 GBP values and grouped by cost components considered in the analysis. All but one of the ICER values are below the accepted £30,000/QALY threshold [43]. Although these therapies stay under the ICER threshold, it is important to note that they are not curative treatments and they only ameliorate the symptoms of the disease. However, the low ICER values are a reflection of significant impacts on quality of life and/or QALYs. Thus, further research is needed in this population to further understand both the clinical effects and the quality-of-life aspects.Fig. 2

Bottom Line: Most treatments did not improve visual acuity significantly.There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden.There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

View Article: PubMed Central - PubMed

Affiliation: Valid Insight®, Kemp House, 152 City Road, London, EC1V 2NX, UK. sbradshaw@validinsight.com.

ABSTRACT

Background: To understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).

Methods: We conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.

Results: A total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.

Conclusions: There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

No MeSH data available.


Related in: MedlinePlus