Purpose

To highlight the financial incentive to the physician of choosing an intravitreal anti-vascular endothelial growth factor (VEGF)-based strategy for treating non-proliferative and proliferative diabetic retinopathy, and its possible risks to the patient and costs to the health care system.

Design

Perspective with retrospective cost and profit analysis.

Methods

Review and synthesis of selected literature on the treatment of diabetic retinopathy, with interpretation of activity-based and time-based costing of an intravitreal aflibercept strategy for diabetic retinopathy. Data from the DRCR Retina Network Protocols W and AB and PANORAMA trial were used to illustrate the potential financial incentive underlying such a treatment strategy.

Results

Physician treatment algorithms for diabetic vitreous hemorrhage and non-proliferative diabetic retinopathy may be influenced by the substantial financial incentives that intravitreal aflibercept strategies present, despite functional equivalence with alternative and less profitable strategies. For example, pursuing an intravitreal aflibercept-based strategy for diabetic vitreous hemorrhage presents a 76% increased profit over pars plana vitrectomy with laser, with equivalent functional outcomes. For non-proliferative diabetic retinopathy, preventative aflibercept injections represent a potential 414% increase in profit over observation and an increased cost of $12,164 to $17,542 over 2 years per patient, with no improvement in visual function. These findings demonstrate that there may be misaligned financial incentives in the management of diabetic retinopathy.

Conclusions

While anti-VEGF therapy is a useful tool in the management of proliferative diabetic retinopathy and diabetic macular edema, it is believed that physicians should avoid overreliance on anti-VEGF injections in the treatment of diabetic retinopathy. Retinal specialists should be cognizant of the limitations, costs, and risks of anti-VEGF monotherapy and prophylactic therapy, and of the imperative to avoid bias towards financially remunerative practice patterns when equally effective alternatives exist.

中文翻译：

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关于糖尿病性视网膜病变抗血管内皮生长因子治疗的经济激励的警告

目的

强调医生选择基于玻璃体内抗血管内皮生长因子 (VEGF) 的策略来治疗非增殖性和增殖性糖尿病视网膜病变的经济激励，以及它可能给患者带来的风险和医疗保健系统的成本。

设计

具有追溯成本和利润分析的视角。

方法

回顾和综合关于治疗糖尿病性视网膜病变的选定文献，解释基于活动和基于时间的玻璃体内阿柏西普策略治疗糖尿病性视网膜病变的成本。来自 DRCR 视网膜网络协议 W 和 AB 以及 PANORAMA 试验的数据被用来说明这种治疗策略背后的潜在经济激励。

结果

医生对糖尿病性玻璃体出血和非增殖性糖尿病性视网膜病变的治疗算法可能会受到玻璃体腔注射阿柏西普策略所带来的实质性经济激励的影响，尽管与替代和利润较低的策略具有功能等效性。例如，针对糖尿病性玻璃体出血采用基于玻璃体内阿柏西普的策略比使用激光进行睫状体玻璃体切除术的利润增加了 76%，并具有相同的功能结果。对于非增殖性糖尿病性视网膜病变，预防性阿柏西普注射代表潜在的利润比观察增加 414%，每名患者的成本在 2 年内增加 12,164 美元至 17,542 美元，而视觉功能没有改善。

结论

虽然抗 VEGF 疗法是治疗增殖性糖尿病性视网膜病变和糖尿病性黄斑水肿的有用工具，但据信医生在治疗糖尿病性视网膜病变时应避免过度依赖抗 VEGF 注射。视网膜专家应该认识到抗 VEGF 单一疗法和预防性疗法的局限性、成本和风险，并且当存在同样有效的替代方案时，必须避免偏向于经济上有利可图的实践模式。