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Dexamethasone implant for non-infectious uveitis: is it cost-effective?
  1. Hazel Squires1,
  2. Iñigo Bermejo1,
  3. Edith N Poku1,
  4. Katy Cooper1,
  5. John Stevens1,
  6. Jean Hamilton1,
  7. Ruth Wong1,
  8. Alastair K Denniston2,
  9. Ian Pearce3,
  10. Fahd Mohammed Quhill4
  1. 1Health Economics and Decision Sciences (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  2. 2Institute of Inflammation and Ageing, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3Clinical Eye Research Centre, St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  4. 4Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Hazel Squires, SHARR, University of Sheffield, Sheffield S1 4DA, UK; h.squires{at}sheffield.ac.uk

Abstract

Background Uveitis is inflammation inside the eye. The objective of this study is to assess the cost-effectiveness of a dexamethasone implant plus current practice (immunosuppressants and systemic corticosteroids) compared with current practice alone, in patients with non-infectious intermediate, posterior or pan-uveitis and to identify areas for future research.

Methods A Markov model was built to estimate the costs and benefits of dexamethasone. Systematic reviews were performed to identify available relevant evidence. Quality of life data from the key randomised-controlled trial (HURON) was used to estimate the interventions’ effectiveness compared with the trial’s comparator arm (placebo plus limited current practice (LCP)). The analysis took a National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources.

Results The incremental cost-effectiveness ratio (ICER) of one dexamethasone implant compared with LCP is estimated as £19 509 per quality-adjusted life year (QALY) gained. The factors with the largest impact on the results were rate of blindness and relative proportion of blindness cases avoided by dexamethasone. Using plausible alternative assumptions, dexamethasone could be cost saving or it may be associated with an ICER of £56 329 per QALY gained compared with LCP.

Conclusions Dexamethasone is estimated to be cost-effective using generally accepted UK thresholds. However, there is substantial uncertainty around these results due to scarcity of evidence. Future research on the following would help provide more reliable estimates: effectiveness of dexamethasone versus current practice (instead of LCP), with subgroup analyses for unilateral and bilateral uveitis, incidence of long-term blindness and effectiveness of dexamethasone in avoiding blindness.

  • uveitis
  • cost-effectiveness analysis
  • technology assessment
  • vision
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Footnotes

  • Contributors HS led the project and advised on the cost-effectiveness modelling. IB undertook the cost-effectiveness review and developed the cost-effectiveness model. EP and KC undertook the clinical effectiveness review. JS and JH commented on statistical issues and feasibility of network meta-analysis and RW performed the literature searches. AKD, IP and FMQ provided clinical advice. All authors were involved in drafting and commenting on the manuscript.

  • Funding This work was supported by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program (project number 15/64/07). Any views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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