OBJECTIVES : To estimate the economic impact following the introduction of dexamethasone intravitreal implant (700 μg; DXI) for treatment of diabetic macular oedema (DMO) from the Italian National Health System (NHS) perspective.

METHODS : This model-based analysis compared two health impact scenarios: a baseline scenario that considers the current market shares of anti-vascular endothelial growth factor (VEGF) agents and a scenario that provides for greater use of DXI. From the population ≥50 years of age residing in Italy on January 1, 2019, identified from the Italian National Institute of Statistics (ISTAT) database, those with diabetic pathology (N= 1,457,031; 5.4%) and with reduced visual capacity (N= 99,078; 6.8%) were selected. The analysis was conducted in patients diagnosed with DMO and eligible for intravitreal therapy (N= 24,770; 25.0%). Market shares of drug therapies (excluding bevacizumab) were obtained from the IQVIA database (Moving Annual Total to March 2019). The number of injections of each anti-VEGF agent was estimated according to treatment schedules in the Summary of Product Characteristics or clinical trials, and parameterized based on the time horizon of analysis. For each agent, a minimum and maximum range of administration frequencies was reported. Direct drug treatment costs (acquisition and administration) were considered.

RESULTS : Assuming an incremental treatment rate of 1,000 patients/year with DXI compared with ranibizumab, the most frequently used anti-VEGF nationally, the estimated annual saving ranged from 2.8% (- €3,708,300) at the simulated minimum administration frequency to 4.8% (- €7,942,400) at the simulated maximum treatment frequency. The resources released would allow treatment of 759 to 1,293 new patients over 12 months, with the potential benefit of reduced waiting lists.

CONCLUSIONS : The results show that incremental use of DXI is associated with significant economic advantages in both simulations, with estimated cost savings being directly proportional to its degree of market penetration.