Use of Bevacizumab and Aflibercept in the Treatment of Diabetic Macular Edema: Cost-effectiveness Analysis

Background: The aim of this study was to evaluate the efficacy of aflibercept by comparison with bevacizumab in the treatment of diabetic macular edema.Methods: The study included 159 patients; the first group consisted of 58 patients who underwent intravitreal application of aflibercept, and the second group of 101 patients underwent intravitreal application of bevacizumab.Main Findings: There was a statistically significant decrease in edema during the optical coherence tomography (OCT) scans after the application of bevacizumab (533±152 μm vs. 384±104 μm, p<0.001) and aflibercept (500±110 μm vs. 354±80 μm, p<0.001). Moreover, a significant increase in central visual acuity was observed both for bevacizumab (0.29±0.20 μm vs. 0.36±0.22 μm, p<0.001) and aflibercept (0.40±0.30 μm vs. 0.48±0.31 μm, p<0.001). Principal Conclusion: Anintravitreal application of either aflibercept or bevacizumab resulted in a significant reduction in macular edema and a significant increase in central visual acuity. Although statistically more efficient, aflibercept use can hardly be justified, due to the high cost associated with its use. Bevacizumab achieved a higher cost-effectiveness compared with aflibercept. Therefore, its use should be considered depending on various healthcare systems, as well as socio-economic factors. Key words: diabetic retinopathy, diabetic macular edema, bevacizumab, aflibercept, optical coherence tomography, visual acuity