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Purpose <p>This systematic review aims to evaluate the cost-effectiveness of anti–vascular endothelial growth factor (anti-VEGF) drugs in the treatment of diabetic macular edema (DME), providing a comprehensive synthesis of economic and quality of life outcomes.</p> Methods <p>A systematic review was conducted following PRISMA guidelines. Scopus, PubMed, Embase, and Web of Science core collection, DARE, NHSEED, HTA, and Google scholar were searched to September 7, 2025, without language or publication type restrictions. Eligible studies compared the cost-effectiveness of anti-VEGF drugs for DME. We extracted economic outcomes from each study, including incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALYs) and costs, and evaluated methodological quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. All costs were adjusted to 2024 US dollars.</p> Results <p>Of 2,136 studies identified, 12 met the inclusion criteria. Findings were heterogeneous across settings and perspectives. Bevacizumab showed the greatest economic value, achieving comparable gains in visual acuity to aflibercept and ranibizumab at a substantially lower cost, while differences between ranibizumab and aflibercept were less consistent and varied across studies. Conbercept, assessed in one Chinese study, dominated ranibizumab in real-world conditions. Faricimab, analyzed in the UK, Colombia, and Japan, was consistently cost-effective or dominant relative to ranibizumab, aflibercept, bevacizumab, and brolucizumab, primarily due to fewer injections and lower monitoring costs. Cost-effectiveness varied with assumptions about time horizon, pricing, treatment frequency, perspective, and willingness-to-pay (WTP) thresholds.</p> Conclusion <p>Evidence suggests that bevacizumab remains the most cost-effective first-line treatment compared to aflibercept and ranibizumab where permitted. Newer agents such as faricimab show promising cost and efficacy profiles, suggesting potential for more sustainable DME management.</p>

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Cost-effectiveness analysis of anti-VEGF drugs in the treatment of visual impairment due to diabetic macular edema: A systematic review

  • 期刊论文

  • 发表日期：

    2026年2月25日

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  • Mojtaba Hasoumi,
  • Vahid Alipour,
  • Hamid Ahmadieh,
  • Jalal Arabloo,
  • Reza Jahangiri

摘要

Purpose

This systematic review aims to evaluate the cost-effectiveness of anti–vascular endothelial growth factor (anti-VEGF) drugs in the treatment of diabetic macular edema (DME), providing a comprehensive synthesis of economic and quality of life outcomes.

Methods

A systematic review was conducted following PRISMA guidelines. Scopus, PubMed, Embase, and Web of Science core collection, DARE, NHSEED, HTA, and Google scholar were searched to September 7, 2025, without language or publication type restrictions. Eligible studies compared the cost-effectiveness of anti-VEGF drugs for DME. We extracted economic outcomes from each study, including incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALYs) and costs, and evaluated methodological quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. All costs were adjusted to 2024 US dollars.

Results

Of 2,136 studies identified, 12 met the inclusion criteria. Findings were heterogeneous across settings and perspectives. Bevacizumab showed the greatest economic value, achieving comparable gains in visual acuity to aflibercept and ranibizumab at a substantially lower cost, while differences between ranibizumab and aflibercept were less consistent and varied across studies. Conbercept, assessed in one Chinese study, dominated ranibizumab in real-world conditions. Faricimab, analyzed in the UK, Colombia, and Japan, was consistently cost-effective or dominant relative to ranibizumab, aflibercept, bevacizumab, and brolucizumab, primarily due to fewer injections and lower monitoring costs. Cost-effectiveness varied with assumptions about time horizon, pricing, treatment frequency, perspective, and willingness-to-pay (WTP) thresholds.

Conclusion

Evidence suggests that bevacizumab remains the most cost-effective first-line treatment compared to aflibercept and ranibizumab where permitted. Newer agents such as faricimab show promising cost and efficacy profiles, suggesting potential for more sustainable DME management.