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Jade Gieseke Gieseke Guevara, Sarina Mahesh Amin, Swati Agarwal; Retrospective cost-benefit analysis of retinopathy of prematurity (ROP) screening, follow-up, and treatment with intravitreal bevacizumab. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5549. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Literature shows that recurrence of ROP with intravitreal bevacizumab (IVB) occurs later than with conventional laser. The American Academy of Pediatrics recommends infants treated with IVB have weekly examination until the retina is fully vascularized. However, anecdotal reports exist of persistent avascular retina following IVB until nine months of age. In this study we define a shorter follow-up protocol after IVB and analyze the costs, benefits, and risks.
Retrospective chart review of 23 infants treated for Type 1 ROP with IVB monotherapy between 7/2014 to 11/2016 at the University of Florida was performed. Data collection included gestational age (GA), birth weight (BW), postmenstrual age (PMA) at IVB treatment and Stage 3 ROP recurrence, number and cost of treatments and examinations, and adverse events from IVB. Total cost for each patient was calculated from cost associated with CPT codes.
Of the 23 infants treated with IVB monotherapy, 1 infant died, 3 moved, and 19 were followed. 13 infants completed weekly follow-up examination until 55 weeks PMA, and 8 of these infants were followed until 9 months of age. Average GA was 24.9 weeks. Average PMA at treatment and recurrence was 37.25 and 43.75 weeks respectively. A total of 4 infants had recurrence of Stage 3 ROP. The average number of IVB treatments was 2.05. All 8 infants followed until 9 months of age showed persistent avascular retina on Retcam photos and fluorescein angiography. No adverse outcomes or recurrence was noted in these infants. The average paid cost of ROP screening and treatment in the hospital and outpatient setting was $14k.
The average age of ROP recurrence was 43.75 weeks with IVB monotherapy. A shortened protocol with weekly examinations until 55 weeks PMA, followed by cycloplegic examination at 60 weeks, and one examination under anesthesia with documentation of avascular retina at 65 weeks PMA demonstrates a cost-effective and safe method of following infants with Type 1 ROP treated with IVB monotherapy. Concluding weekly eye examinations at 55 weeks PMA is cost-effective, and involves no risk of recurrence when the retina is not vascularized at 9 months of chronological age. A large prospective multicenter study would be beneficial in order to redefine current ROP follow-up examination guidelines post-IVB treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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