Proof-of-concept calculations to determine the health-adjusted life-year trade-off between intravitreal anti-VEGF injections and transmission of COVID-19.
Clin Exp Ophthalmol
; 48(9): 1276-1285, 2020 12.
Article
en En
| MEDLINE
| ID: mdl-32902023
ABSTRACT
BACKGROUND:
Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission.METHOD:
We performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health-care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed.RESULTS:
Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5-43%).CONCLUSION:
Unless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Agudeza Visual
/
Transmisión de Enfermedad Infecciosa
/
Inhibidores de la Angiogénesis
/
Pandemias
/
SARS-CoV-2
/
COVID-19
/
Degeneración Macular
Tipo de estudio:
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Patient_preference
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Clin Exp Ophthalmol
Asunto de la revista:
OFTALMOLOGIA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Nueva Zelanda