Economic Evaluation on Diabetic Retinopathy Treatment at Private Eye Hospital in Surabaya

Diabetic retinopathy (DR) is a leading cause of visual impairment and blindness worldwide, with a growing global burden, particularly in low- and middle-income countries. This study aimed to evaluate the cost-effectiveness of panretinal photocoagulation (PRP) alone compared with PRP combined with intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy in a real-world hospital setting in Indonesia. Methods: A retrospective cost-effectiveness analysis was conducted using medical record data from 171 patients with diabetic retinopathy treated in 2021 at a private eye hospital in Surabaya. The analysis was performed from a societal perspective over a one-year time horizon using a Markov model with 6-month cycles. Costs included direct medical and indirect costs. Health outcomes were measured using Disability-Adjusted Life Years (DALYs). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analysis was performed to assess uncertainty. Results: The total cost of PRP combined with anti-VEGF therapy was higher than PRP alone (IDR 16,771,000 vs IDR 14,171,000). However, the combination therapy resulted in substantially greater health benefits, with 12.793 DALYs averted compared to 0.932 DALYs for PRP alone. The ICER was IDR 173,960,796 per DALY averted, which falls within the WHO-CHOICE cost-effectiveness threshold for Indonesia (2.86 times GDP per capita). Sensitivity analysis confirmed the robustness of these findings. Conclusion: PRP combined with intravitreal anti-VEGF therapy is a cost-effective strategy for managing diabetic retinopathy in Indonesia. These findings support its consideration in clinical practice and health policy to reduce the burden of visual impairment.