Visual impairment is a common problem among Veterans and results in significant reduction in quality of life. Diseases commonly responsible for substantial losses in visual acuity include neovascular (“wet”) age-related macular degeneration (AMD), diabetic macular edema (DME), and central or branch retinal vein occlusion (CRVO or BRVO). While the etiologies of these diseases are complex, all are driven at least in part by vascular endothelial growth factors (VEGFs). This has led to the development of several drugs called anti-VEGF agents designed to block these factors and thus limit their damage to the eye. The most commonly used anti-VEGF agents—aflibercept, bevacizumab, and ranibizumab—have been shown to slow and even reverse the vision loss typically seen in patients with AMD, DME, BRVO, and CRVO. The comparative effectiveness, harms, and costs of these drugs are unclear.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. What is the comparative clinical effectiveness of anti-VEGF agents for retinal/choroidal neovascularization and/or macular edema in adults?
  • KEY QUESTION 2. What are the comparative harms of anti-VEGF agents for retinal/choroidal neovascularization and/or macular edema in adults?
  • KEY QUESTION 3. What is the comparative cost-effectiveness of anti-VEGF agents for retinal/choroidal neovascularization and/or macular edema in adults?
• SUMMARY AND DISCUSSION
  • SUMMARY OF THE EVIDENCE
  • LIMITATIONS
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. QUALITY ASSESSMENT
• APPENDIX C. PEER REVIEW COMMENTS AND AUTHOR RESPONSES
• APPENDIX D. DETAILED DATA ABSTRACTION

Suggested citation:

Low A, Kansagara D, Freeman M, Fu R, Bhavsar K, Faridi A, Kondo K, Paynter R. Comparative Clinical and Economic Effectiveness of Anti-Vascular Endothelial Growth Factor Agents. VA ESP Project #05-225; 2017.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the VA Portland Health Care System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.