The use of intravitreal bevacizumab in the initial treatment of diabetic macular edema (DME) in a resident lead clinic in a county hospital, and comparative cost saving compared to other anti VEGF therapies.

Abstract

Purpose : To determine the efficacy of use of intravitreal bevacizumab in the initial treatment of diabetic macular edema (DME) in a resident lead clinic in a county hospital, and comparative cost saving compared to other anti VEGF therapies.

Methods : Data collected on 25 eyes using retrospective chart review of patients presenting to the resident led Retina clinic with new onset DME. All patients received an initial baseline OCT with measurement of the central macular thickness (CMT), followed by a course of 3 consecutive intravitreal injections followed by response assessment with OCT and BCVA. Response was monitored by change in BCVA and CMT. Total number of intravitreal avastin injections performed in 1 year in our insttution was calculated with calculation of savings compared to intravitreal ranibizumab.

Results : Total of 25 eyes received a course of intravitreal injections for new onset DME. Average preinjection CMT ranged from 310 to 705, with provisional results suggesting a dramatic improvement in CMT of 220 to 402, representing 42% reduction in CMT (p<0.01) at follow up. Average improvement in BCVA was 2 lines or better (p<0.02). Total cost of a course of three intravitreal bevacizumab was $150 from our inhouse compounding pharmacy compared to $6000 for intravitreal ranibizumab.

Conclusions : In the resident led clinic, intravitreal injections are highly effective in the initial treatment of DME with excellent reduction in CMT, and BCVA. Moreover compounded intravitreal avastin costs between $30-50 compared to equivalent cost of ranibizumab of $2000. In our county institution this represents a dramatic saving in therapy for DME with proven clinical efficacy. With current climate of providing efficacious care at the lowest cost, and the ever increasing burden of diabetic retinopathy, compounded intravitreal bevacizumab may be an attractive alternative in the public healthcare setting.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.