RESUMO
BACKGROUND: In 2020 Colombia may expect to have close to 231,700 patients with neovascular age-related macular degeneration (ARMD). Treatment of neovascular ARMD involves the sequential Intra-vitreal injections of anti-vascular endothelial growth factor (anti-VEGF therapy) medications. The efficacy and safety of anti-VEGF therapy on a treat-and-extend (T&E) dosing scheme are similar when ranibizumab or aflibercept are administered. Objective : A cost-minimization analysis from the payer`s perspective in Colombia projects treatment expenses of anti-VEGF therapy using aflibercept or ranibizumab on T&E regimens for the treatment of neovascular ARMD. Methods : A model projects the expenses of the compared treatment regimens for two and five-year periods beginning on February 2020. The model used information from clinical trials, case series and meta-analyses on the compared treatment regimens, demographic, epidemiologic and economic data originated from the Colombian government sources. A 3% discount rate was applied. Results : Projected cost differences in favor of ranibizumab after two and five-year treatment periods beginning February 2020 could be close to U.S. $ 4,861 and U.S $ 7,241 per treated eye, respectively. If all patients with unilateral and bilateral neovascular ARMD in Colombia were to receive appropriate anti-VEGF therapy for two years, the projected expected cost difference in favor of ranibizumab could be close to U.S. $ 462,717,092 dollars. Conclusion : Within the Colombian healthcare setting anti-VEGF therapy on a T&E regimen utilizing ranibizumab for neovascular ARMD may be cost-saving compared with employing aflibercept. Despite cost favorability, ranibizumab should not be the only therapeutic option since in clinical practice alternatives are required.
Assuntos
Degeneração Macular , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Inibidores da Angiogênese/uso terapêutico , Colômbia , Custos e Análise de Custo , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade VisualRESUMO
PURPOSE: To study the efficacy of inferior, single-segment, 80% stromal depth Intacs severe keratoconus (SK) intracorneal ring segment implantation. DESIGN: A prospective case series. METHODS: Eighteen eyes from 15 patients with asymmetric keratoconus underwent 80% stromal depth Intacs SK single inferior segment implantation, using an IntraLase femtosecond laser for tunnel creation. Parameters studied included preoperative and postoperative uncorrected and best-corrected visual acuity (VA), manifest refraction and elevation-based computerized corneal topography. RESULTS: Patients' VA was tested with Early Treatment Diabetic Retinopathy Study (ETDRS) chart. All the eyes demonstrated a significant ETDRS line improvement of 5.4 ± 2.0 after a follow-up period of 8.9 ± 3.9 months. Thirteen eyes (72%) showed a line improvement of 4 or more. Best-corrected VA remained unchanged in 8 eyes (44%) while 7 eyes (39%) showed a line improvement of 1 to 8. Sixteen eyes (89%) had a significant change in manifest cylinder [3.0 ± 2.2 diopters (D)]. Of the 18 eyes, astigmatism reduction was 3.44 ± 1.98 D, from 5.6 ± 2.2 D preoperatively to 2.5 ± 1.5 D postoperatively (P < 0.05). Implant placement reduced both preexisting hyperopic and myopic spheres in 14 cases (78%). Although one case showed a significant postoperative regression of the obtained correction, Intacs SK implantation was safe and effective in all the other cases. CONCLUSIONS: Femtosecond laser-assisted single-segment Intacs SK (80% depth intrastromal placement) is a safe and effective technique for improving uncorrected and best-corrected VA and correcting both spherical and cylindrical refractive errors in eyes with severe asymmetric keratoconus.