WAIKOLOA, Hawaii — Jetrea may not be as cost-effective as vitrectomy for vitreomacular adhesion and macular hole closure, a speaker told colleagues here.
“You’ve got to decide what’s best for your patients, recognizing that ocriplasmin will not achieve a success rate anywhere near that of a single operation, and to look at this issue of cost-adjustment,” William F. Mieler, MD, said at Retina 2016. “Perhaps ocriplasmin is just as expensive as a surgery. These issues are still ongoing. I still use ocriplasmin on occasion, but I think most of my patients opt for a vitrectomy approach, at least in my setting.”
William F. Mieler
In 1993, Wendell and colleagues recognized that macular holes could be treated surgically; they reported a 58% success rate, Mieler said.
“Since that time, we now have about a 95% success rate in terms of closure of macular holes,” he said.
Jetrea (ocriplasmin, ThromboGenics) was approved by the FDA in 2012 to treat vitreomacular adhesion. The MIVI-TRUST trial showed that macular holes closed in 40.6% of patients at 28 days, Mieler said.
“We’re not talking 95% as you can do surgically, but if this is a less expensive office-based procedure, we have to advise our patients that, yes, the success rate is not as high, but it might be a less expensive and less time-consuming situation,” Mieler said.
Phakic patients with smaller macular holes, age younger than 65 years and no epiretinal membrane tend to do better with ocriplasmin, Mieler said.
Ocriplasmin has been used in about 6,500 patients in the U.S., he said.
Chang and Smiddy reported in 2014 that cost per quality-adjusted life years was $5,444 to $7,442 for vitrectomy and $8,150 to $10,244 for ocriplasmin.
Kaiser and colleagues reported risks and complications of ocriplasmin in the MIVI-TRUST trials included non-release of vitreomacular adhesion and/or non-closure of macular hole; transient photopsia; dyschromatopsia; retinal tear; retinal detachment; transient visual loss; lens subluxation; and rare and transient structural alteration of the inner retina. – by Matt Hasson and Patricia Nale, ELS
Disclosure: Mieler reports he has served as a consultant for Acucela, Genentech and ThromboGenics.