Date of download: 6/3/2016 From: Cost-Effectiveness of Treatment of Diabetic Macular Edema Ann Intern Med. 2014;160(1):18-29. doi:10.7326/M13-0768 Markov.

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Date of download: 6/3/2016 From: Cost-Effectiveness of Treatment of Diabetic Macular Edema Ann Intern Med. 2014;160(1): doi: /M Markov model schematic. The 6 alternatives to the right of the decision node (square box) represent the 6 strategies for comparison, each progressing within the Markov model. The shaded boxes represent the Markov model transitions for progression of diabetic macular edema. Visual acuity categories 1 through 6 represent states of visual acuity (Table 1). Solid arrows represent possible worsening (progression) within a given month, and dashed arrows represent the potential for improvement or progression within a given month while receiving treatment. On-treatment states are subject to risk for complications (arterial thromboembolic events, glaucoma, cataracts, and other major or minor complications). In the base case, treatment was stopped after 1 y for all strategies or sooner if an arterial thromboembolic event or severe glaucoma occurred. VEGF = vascular endothelial growth factor.* Off or after treatment. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/3/2016 From: Cost-Effectiveness of Treatment of Diabetic Macular Edema Ann Intern Med. 2014;160(1): doi: /M One-year treatment and lifetime treatment cost-effectiveness frontiers. Discounted lifetime costs and QALYs associated with the 6 strategies. The top panel represents the main analysis, with 1 y of treatment with lifetime follow-up. The bottom panel represents lifetime treatment with 3 VEGF inhibitor injections per year (monotherapy or combination therapy), 1 triamcinolone injection per year (monotherapy or combination therapy), 1 laser treatment every other year in laser monotherapy, and no additional laser treatments in combination therapy strategies. The solid black line indicates the cost-effectiveness frontier, which represents the most cost-effective series of strategies (achieving the greatest relative benefit for the lowest cost). The ICERs are indicated in dollars per QALY, representing the cost of additional effectiveness relative to the next best strategy (this figure compares the preferred strategy of laser therapy plus VEGF inhibitors with laser therapy plus triamcinolone, with an ICER of $12 410/QALY with 1 y of treatment and an ICER of $26 477/QALY with treatment over a lifetime). The strategies that form the cost-effectiveness frontier (laser therapy plus triamcinolone and laser therapy plus VEGF inhibitors, each depicted with a solid black circle) dominate those to the right of the frontier (gray circles) because they are more cost-effective and cost less (strong dominance) or have a better cost-effectiveness ratio (weak dominance). ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life-year; VEGF = vascular endothelial growth factor. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

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