1
|
Pesonen M, Jylhä V, Kankaanpää E. Adverse drug events in cost-effectiveness models of pharmacological interventions for diabetes, diabetic retinopathy, and diabetic macular edema: a scoping review. JBI Evid Synth 2024:02174543-990000000-00336. [PMID: 39054883 DOI: 10.11124/jbies-23-00511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The objective of this review was to examine the role of adverse drug events (ADEs) caused by pharmacological interventions in cost-effectiveness models for diabetes mellitus, diabetic retinopathy, and diabetic macular edema. INTRODUCTION Guidelines for economic evaluation recognize the importance of including ADEs in the analysis, but in practice, consideration of ADEs in cost-effectiveness models seem to be vague. Inadequate inclusion of these harmful outcomes affects the reliability of the results, and the information provided by economic evaluation could be misleading. Reviewing whether and how ADEs are incorporated in cost-effectiveness models is necessary to understand the current practices of economic evaluation. INCLUSION CRITERIA Studies included were published between 2011-2022 in English, representing cost-effectiveness analyses using modeling framework for pharmacological interventions in the treatment of diabetes mellitus, diabetic retinopathy, or diabetic macular edema. Other types of analyses and other types of conditions were excluded. METHODS The databases searched included MEDLINE (PubMed), CINAHL (EBSCOhost), Scopus, Web of Science Core Collection, and NHS Economic Evaluation Database. Gray literature was searched via the National Institute for Health and Care Excellence, European Network for Health Technology Assessment, the National Institute for Health and Care Research, and the International Network of Agencies for Health Technology Assessment. The search was conducted on January 1, 2023. Titles and abstracts were screened for inclusion by 2 independent reviewers. Full-text review was conducted by 3 independent reviewers. A data extraction form was used to extract and analyze the data. Results were presented in tabular format with a narrative summary, and discussed in the context of existing literature and guidelines. RESULTS A total of 242 reports were extracted and analyzed in this scoping review. For the included analyses, type 2 diabetes was the most common disease (86%) followed by type 1 diabetes (10%), diabetic macular edema (9%), and diabetic retinopathy (0.4%). The majority of the included analyses used a health care payer perspective (88%) and had a time horizon of 30 years or more (75%). The most common model type was a simulation model (57%), followed by a Markov simulation model (18%). Of the included cost-effectiveness analyses, 26% included ADEs in the modeling, and 13% of the analyses excluded them. Most of the analyses (61%) partly considered ADEs; that is, only 1 or 2 ADEs were included. No difference in overall inclusion of ADEs between the different conditions existed, but the models for diabetic retinopathy and diabetic macular edema more often omitted the ADE-related impact on quality of life compared with the models for diabetes mellitus. Most analyses included ADEs in the models as probabilities (55%) or as a submodel (40%), and the most common source for ADE incidences were clinical trials (65%). CONCLUSIONS The inclusion of ADEs in cost-effectiveness models is suboptimal. The ADE-related costs were better captured than the ADE-related impact on quality of life, which was most pronounced in the models for diabetic retinopathy and diabetic macular edema. Future research should investigate the potential impact of ADEs on the results, and identify the criteria and policies for practical inclusion of ADEs in economic evaluation.
Collapse
Affiliation(s)
- Mari Pesonen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Virpi Jylhä
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Centre for Nursing Science and Social and Health Management, Kuopio University Hospital, Wellbeing Services County of North Savo, Finland
| | - Eila Kankaanpää
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
2
|
Feo A, De Simone L, Cimino L, Angi M, Romano MR. Differential diagnosis of myopic choroidal neovascularization (mCNV): insights from multimodal imaging and treatment implications. Graefes Arch Clin Exp Ophthalmol 2024; 262:2005-2026. [PMID: 38060000 DOI: 10.1007/s00417-023-06320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/31/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE The aim of this article is to conduct a comprehensive systematic review about the current understandings and differential diagnosis of myopic choroidal neovascularization (mCNV) and other several similar diseases, describing their multimodal imaging analysis, prognostic implications, and current types of management. METHODS This systematic review was performed based on a search on the PubMed database of relevant papers regarding mCNV and other entities discussed in the paper, according to our current knowledge. RESULTS Through the integration of a multimodal imaging approach, especially optical coherence tomography (OCT), along with accurate demographic and clinical assessment, it becomes possible to effectively differentiate mCNV from similar yet heterogeneous entities. These conditions include macular hemorrhage due to new lacquer crack (LC) formation, inflammatory diseases such as punctate inner choroidopathy (PIC)/multifocal choroidits (MFC) and epiphenomenon multiple evanescent white dot syndrome (Epi-MEWDS), neovascular age-related macular degeneration (nAMD), idiopathic CNV (ICNV), dome-shaped macula (DSM) with subretinal fluid, retinal pigment epithelium (RPE) humps, angioid streaks (AS), choroidal rupture (CR), and choroidal osteoma (CO). Each one of these entities will be described and discussed in this article. CONCLUSION Myopic choroidal neovascularization is a common retinal condition, especially among young individuals. Accurate diagnosis and differentiation from similar conditions are crucial for effective treatment. Multimodal imaging, particularly OCT, plays a crucial role in precise assessment. Future research should focus on defining biomarkers and distinguishing features to facilitate prompt treatment.
Collapse
Affiliation(s)
- Alessandro Feo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele-Milan, Italy.
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Martina Angi
- Ocular Oncology Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele-Milan, Italy
- Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy
| |
Collapse
|
3
|
He Z, Huang X, Chen D, Wang G, Zhu Y, Li H, Han S, Shi L, Guan X. Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review. BMJ Glob Health 2023; 8:e012780. [PMID: 38030227 PMCID: PMC10689407 DOI: 10.1136/bmjgh-2023-012780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND China's National Reimbursement Drug List (NRDL) has become the primary route for drug reimbursement in China. More recently, the authority has made pharmacoeconomic evaluation an integral part of the application for NRDL inclusion. The underlying financial conflict of interests (FCOI) of pharmacoeconomic evaluations, however, has the potential to influence evidence generated and thus subsequent decision-making yet remains poorly understood. METHODS We searched for studies published between January 2012 and January 2022 on the 174 drugs added to the 2017-2020 NRDLs after successful negotiation. We categorised the study's FCOI status into no funding, industry funding, non-profit funding and multiple fundings based on authors' disclosure and assessed the reporting quality of included studies using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. We compiled descriptive statistics of funding types and study outcomes using t-tests and χ2 tests and conducted multivariate regression analysis. RESULTS We identified 378 records and our final sample included 92 pharmacoeconomic evaluations, among which 69.6% were conducted with at least one funding source. More than half (57.6%) of the evaluations reached favourable conclusions towards the intervention drug and 12.6% reached a dominant result of the intervention drug over the comparison from model simulation. The reporting quality of included studies ranged from 19 to 25 (on a scale of 28), with an average of 22.3. The statistical tests indicated that industry-funded studies were significantly more likely to conclude that the intervention therapy was economical (p<0.01) and had a significantly higher proportion of resulting target drug economically dominated the comparison drug (p<0.05). CONCLUSION The study revealed that FCOI bias is common in published pharmacoeconomic evaluations conducted in Chinese settings and could significantly influence the study's economical results and conclusions through various mechanisms. Multifaceted efforts are needed to improve transparency, comparability and reporting standardisation.
Collapse
Affiliation(s)
- Zixuan He
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xianqin Huang
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dingyi Chen
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Guoan Wang
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Yuezhen Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| |
Collapse
|
4
|
Agyekum S, Chan PP, Zhang Y, Huo Z, Yip BHK, Ip P, Tham CC, Chen LJ, Zhang XJ, Pang CP, Yam JC. Cost-effectiveness analysis of myopia management: A systematic review. Front Public Health 2023; 11:1093836. [PMID: 36923029 PMCID: PMC10008871 DOI: 10.3389/fpubh.2023.1093836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
The rising prevalence of myopia is a major global public health concern. Economic evaluation of myopia interventions is critical for maximizing the benefits of treatment and the healthcare system. This systematic review aimed to evaluate the cost-effectiveness of interventions for treating myopia. Five databases were searched - Embase, Emcare, PubMed, Web of Science, and ProQuest - from inception to July 2022 and a total of 2,099 articles were identified. After careful assessments, 6 studies met the eligibility criteria. The primary outcomes of this systematic review were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The secondary outcomes included utility values and net monetary benefits (NMB). One study determined the cost-effectiveness of photorefractive screening plus treatment with 0.01% atropine, 2 studies examined cost-effectiveness of corneal refractive surgery, and 3 studies evaluated cost-effectiveness of commonly used therapies for pathologic myopia. Corneal refractive surgeries included laser in situ keratomileusis (LASIK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), photorefractive keratectomy (PRK), and small-incision lenticule extraction (SMILE). Interventions for pathologic myopia included ranibizumab, conbercept, and photodynamic therapy (PDT). At an incremental cost of NZ$ 18 (95% CI 15, 20) (US$ 11) per person, photorefractive screening plus 0.01% atropine resulted in an ICER of NZ$ 1,590/QALY (US$ 1,001/QALY) (95% CI NZ$ 1,390, 1,791) for an incremental QALY of 0.0129 (95% CI 0.0127, 0.0131). The cost of refractive surgery in Europe ranged from €3,075 to €3,123 ([US$4,046 to $4,109 - adjusted to 2021 inflation). QALYs associated with these procedures were 23 (FS-LASIK) and 24 (SMILE and PRK) with utility values of 0.8 and ICERs ranging from approximately €14 (US$17)/QALY to €19 (US$23)/QALY. The ICER of LASIK was US$683/diopter gained (inflation-adjusted). The ICER of ranibizumab and PDT were £8,778 (US$12,032)/QALY and US$322,460/QALY respectively, with conbercept yielding a saving of 541,974 RMB (US$80,163)/QALY, respectively. The use of 0.01% atropine and corneal refractive surgery were cost-effective for treating myopia. Treating pathologic myopia with ranibizumab and conbercept were more cost-effective than PDT. Prevention of myopia progression is more cost-effective than treating pathologic myopia.
Collapse
Affiliation(s)
- Sylvia Agyekum
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Poemen P Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhaohua Huo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology, Hong Kong Children Hospital, Kowloon, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology, Hong Kong Children Hospital, Kowloon, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China.,Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology, Hong Kong Children Hospital, Kowloon, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China.,Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
5
|
Li S, Guo L, Zhou P, Tang J, Wang Z, Zhang L, Zhao M, Qu J. Comparison of efficacy and safety of intravitreal ranibizumab and conbercept before vitrectomy in Chinese proliferative diabetic retinopathy patients: a prospective randomized controlled trial. EYE AND VISION (LONDON, ENGLAND) 2022; 9:44. [PMID: 36451252 PMCID: PMC9714121 DOI: 10.1186/s40662-022-00316-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/05/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND To compare the efficacy and safety of preoperative intravitreal injections of ranibizumab and conbercept in Chinese proliferative diabetic retinopathy (PDR) patients. METHODS This prospective randomized controlled trial enrolled 90 eyes of 80 patients with PDR. Forty-four eyes of 40 patients that received intravitreal ranibizumab (IVR) injections (0.5 mg/0.05 mL) before vitreous surgeries were assigned to the IVR group. Forty-six eyes of 40 patients that received intravitreal conbercept (IVC) injections (0.5 mg/0.05 mL) before vitreous surgeries were assigned to the IVC group. Intraoperative and postoperative indices were assessed for further comparison between the two groups. RESULTS There were no statistically significant differences in all surgery indices, including intraoperative indices (surgery time, P = 0.225; intraoperative bleeding, P = 0.808; endodiathermy use, P = 0.693; incidence of iatrogenic retinal breaks, P = 0.740; relaxing retinotomy, P = 0.682; retinal reattachment, P = 0.682 and silicone oil tamponade, P = 0.814) and postoperative indices (postoperative vitreous hemorrhage (VH), P = 0.808; neovascular glaucoma (NVG), P = 0.964; recurrent retinal detachment, P = 0.531; postoperative fibrovascular proliferation progression, P = 0.682 and reoperation, P = 0.955) between the two groups. There were no statistically significant differences in best-corrected visual acuity (BCVA) at each follow-up visit (P = 0.939, 0.669, 0.741 and 0.717, respectively) or in central retinal thickness (CRT) (P = 0.976, 0.699, 0.551 and 0.686, respectively). As for safety profile, both groups had no ocular or system adverse events during the observation period. CONCLUSIONS IVR and IVC as a pretreatment of vitrectomy had similar efficacy and safety profile for Chinese PDR patients. TRIAL REGISTRATION Registered at ClinicalTrials.gov ( NCT05414149 ).
Collapse
Affiliation(s)
- Siying Li
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| | - Lili Guo
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| | - Pingping Zhou
- grid.452866.bDepartment of Ophthalmology, The First Affiliated Hospital of Jiamusi University, Jiamusi City, Heilongjiang Province China
| | - Jiyang Tang
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zongyi Wang
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| | - Linqi Zhang
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| | - Jinfeng Qu
- grid.411634.50000 0004 0632 4559Department of Ophthalmology, Peking University People’s Hospital, Beijing, China ,Eye Diseases and Optometry Institute, Beijing, China ,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China ,grid.11135.370000 0001 2256 9319College of Optometry, Peking University Health Science Center, Beijing, China
| |
Collapse
|
6
|
Zhang Y, Xu F, Lin Z, Wang J, Huang C, Wei M, Zhai W, Li J. Prediction of Visual Acuity after anti-VEGF Therapy in Diabetic Macular Edema by Machine Learning. J Diabetes Res 2022; 2022:5779210. [PMID: 35493607 PMCID: PMC9042629 DOI: 10.1155/2022/5779210] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To predict visual acuity (VA) 1 month after anti-vascular endothelial growth factor (VEGF) therapy in patients with diabetic macular edema (DME) by using machine learning. METHODS This retrospective study included 281 eyes with DME receiving intravitreal anti-VEGF treatment from January 1, 2019, to April 1, 2021. Eighteen features from electronic medical records and measurements data from OCT images were extracted. The data obtained from January 1, 2019, to November 1, 2020, were used as the training set; the data obtained from November 1, 2020, to April 1, 2021, were used as the validation set. Six different machine learning algorithms were used to predict VA in patients after anti-VEGF therapy. After the initial detailed investigation, we designed an optimization model for convenient application. The VA predicted by machine learning was compared with the ground truth. RESULTS The ensemble algorithm (linear regression + random forest regressor) performed best in VA and VA variance predictions. In the validation set, the mean absolute errors (MAEs) of VA predictions were 0.137-0.153 logMAR (within 7-8 letters), and the mean square errors (MSEs) were 0.033-0.045 logMAR (within 2-3 letters) for the 1-month VA predictions, respectively. For the prediction of VA variance at 1 month, the MAEs were 0.164-0.169 logMAR (within 9 letters), and the MSEs were 0.056-0.059 logMAR (within 3 letters), respectively. CONCLUSIONS Our machine learning models could accurately predict VA and VA variance in DME patients receiving anti-VEGF therapy 1 month after, which would be much valuable to guide precise individualized interventions and manage expectations in clinical practice.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Qidu Pharmaceutical Co. Ltd., Shandong Provincial Key Laboratory of Neuroprotective Drugs, Zibo, China
| | - Fabao Xu
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhenzhe Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Huang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Wei
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weibin Zhai
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianqiao Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|