Evidence mapPaperPMID 40973776Full record

ArticleEye (London, England)2025

Cost-effectiveness of anti-vascular endothelial growth factor and macular laser treatments for people with centre-involving diabetic macular oedema and central retinal thickness of at least 400 micrometres.

Kirsty Luckham, Hannah Tebbs, Clare Dadswell, Ahmed Yosef, Lindsay Claxton, Kate Kelley, Nichole Taske, Philip I Burgess, Christiana Dinah, Noemi Lois and 1 more

Abstract read
In one paragraph

Article in Eye (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Kirsty LuckhamScience, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, London, UK.ORCID http://orcid.org/0009-0009-2131-6243
Hannah TebbsScience, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, London, UK.
Clare DadswellClinical Evidence, BMJ Technology Assessment Group, London, UK.
Ahmed YosefCentre for Guidelines, National Institute for Health and Care Excellence, London, UK.
Lindsay ClaxtonScience, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, London, UK.
Kate KelleyCentre for Guidelines, National Institute for Health and Care Excellence, London, UK.
Nichole TaskeScience, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, London, UK.
Philip I Burgess *Department of Eye and Vision Science, University of Liverpool, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Christiana Dinah *Research and Innovation, London North West University Healthcare NHS Trust, London, UK.ORCID http://orcid.org/0000-0002-0815-4771
Noemi Lois *Wellcome-Wolfson Institute for Experimental Medicine; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.ORCID http://orcid.org/0000-0003-2666-2937
Syed MohiuddinScience, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, London, UK. syed.mohiuddin@nice.org.uk.ORCID http://orcid.org/0000-0003-4585-3392

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiabetic macular oedema (DMO) is a common cause of vision loss and blindness. To inform the 2024 UK NICE guideline for treating people with centre-involving DMO (CI-DMO) and central retinal thickness (CRT) of ≥400 µm, the cost-effectiveness of various anti-vascular endothelial growth factor (anti-VEGF) and macular laser treatments was evaluated.

methodsA de novo Markov model evaluated the lifetime costs and quality-adjusted life-years (QALYs) of various anti-VEGFs (aflibercept, bevacizumab, brolucizumab, faricimab, ranibizumab and ranibizumab biosimilar), macular lasers (standard threshold laser and subthreshold micropulse laser), and some treatment combinations from the perspective of the UK NHS. The model included eight health states defined by best-corrected visual acuity ranging between >85 and ≤25 letters. The model's inputs were derived from published literature, while an original network meta-analysis of several clinical trials informed visual outcomes.

resultsAll anti-VEGFs demonstrated greater clinical effectiveness and produced more QALYs (ranging from 9.211 to 9.271) than both types of macular lasers (8.928 and 8.944), but lasers were the most cost-effective due to their substantially lower costs. Using confidential price discounts, ranibizumab biosimilar (Ongavia) and brolucizumab had ICERs below £20,000 per QALY, while aflibercept, ranibizumab (Lucentis) and faricimab had ICERs below £25,000 per QALY, compared to no treatment. Bevacizumab was the most cost-effective anti-VEGF treatment due to its significantly lower cost.

conclusionsGiven their clinical and cost-effectiveness at confidential prices, NICE recommends offering a licensed cost-effective anti-VEGF as first-line treatment for people with CI-DMO and CRT ≥ 400 µm. The use of bevacizumab for this population is not licensed in the UK and would be considered off-label.

Indexed as

Angiogenesis InhibitorsDiabetic RetinopathyLaser CoagulationMacular EdemaRetinaVascular Endothelial Growth Factor ABevacizumabCost-Benefit AnalysisHumansIntravitreal InjectionsMarkov ChainsNetwork Meta-Analysis as TopicQuality-Adjusted Life YearsRanibizumabReceptors, Vascular Endothelial Growth FactorRecombinant Fusion ProteinsafliberceptAngiogenesis InhibitorsBevacizumabRanibizumabReceptors, Vascular Endothelial Growth FactorRecombinant Fusion ProteinsVascular Endothelial Growth Factor A

Identifiers

PMID40973776
PMCPMC12583803

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.