The burden of non-infectious intraocular inflammatory eye diseases: a systematic literature review

Abstract

Objective: Non-infectious inflammatory eye diseases (IEDs), although rare, are complex and varied and may result in detrimental effects. A systematic literature review was conducted on the clinical outcome and economic burden of IED.

Methods: The Ovid search platform (Wolters Kluwer) was used to access scientific literature databases, including MEDLINE, Embase, Cochrane libraries, Health Technology Assessment and the NHS Economic Evaluation database. The search strategy targeted clinical and economic outcomes research in 2009–2016. Titles and abstracts resulting from inclusion criteria were screened, and two reviewers independently extracted relevant information from the selected full-text articles.

Results: Thirty-nine papers met the inclusion criteria – 21 clinical trials, 7 database analyses, 6 non-systematic literature reviews with expert commentary, 3 chart reviews, and 2 surveys – which assessed steroids, immunosuppressants, implants and biologics. Patients experienced considerable morbidity, much of which was associated with corticosteroid use. The average annual healthcare costs of patients with IED were $13,728 to $32,268 in 2009 US dollars, which amounted to 3.1 to 8.3 times that of patients without IED. Steroid-releasing intraocular implants were associated with higher up-front costs, close monitoring requirements, potential for implant removal and increased rates of adverse ocular events than systemic steroids.

Conclusions: IEDs are rare and complex conditions that threaten eyesight and impose considerable morbidity as well as a substantial economic burden. This review confirms that further research is needed to more fully explore the burden of IED and treatment-related adverse events, as well as appropriate means for clinicians to intensify treatment.

Keywords:

• Non-infectious inflammatory eye diseases
• uveitis
• economic burden
• healthcare costs
• medical resource utilization

Transparency

Declaration of funding

This study was funded by Mallinckrodt Pharmaceuticals.

Declaration of financial/other relationships

W.W.N. and G.J.W. have disclosed that they are employees of Mallinckrodt Pharmaceuticals. J.B.R., A.G.W. and L.M.S. have disclosed that they are employees of Analysis Group Inc., a consulting company that received funding for this research from Mallinckrodt Pharmaceuticals.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no relevant financial or other relationships to disclose.

Acknowledgements

The authors would like to thank the independent reviewers for their assistance with reviewing papers and extracting data from those included.

Previous presentation: Some of the material contained in this paper was presented at the Academy of Managed Care Pharmacy’s Annual Meeting, Denver, CO, March 2017.