Rodríguez‑Maqueda, M. (Mariano)

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    A multiple stakeholder multicriteria decision analysis in diabetic macular edema management: the MULTIDEX‑EMD study
    (Springer, 2020) Zulueta, J. (Jacinto); Zarranz-Ventura, J. (Javier); Peralta, G. (Gemma); Casado, M. A. (Miguel Ángel); Rodríguez‑Maqueda, M. (Mariano); Ortiz, P. (Pere); Llorente, I. (Iñaki); Álvarez, E. (Eloísa); Garcia-Layana, A. (Alfredo); Trillo, J.L. (José Luis); Poveda, J.L. (José Luis); Mur, C. (Carlos); Martínez‑Olmos, J.(José); Martínez, M. (Mercedes); Martínez‑Sesmero, J.M. (José Manuel); de-Andrés‑Nogales, F. (Fernando); Ignacio, E. (Emilio); Udaondo, P. (Patricia); Cervera, E. (Enrique); Ruiz-Moreno, J.M. (José María)
    Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) ofers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defned all of the criteria that could infuence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was ftted by applying the backward elimination algorithm (relevant criteria: p value<0.05). Finally, the results were discussed in a deliberative process (phase C). Results Thirty-one criteria were initially defned (phase A) and grouped into 5 categories: efcacy/efectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value<0.001), percentage of patients with an improvement of ≥15 letters (p value<0.001), efect duration per administration (p value=0.008), retinal detachment (p value<0.001), endophthalmitis (p value=0.012), myocardial infarction (p value<0.001), intravitreal hemorrhage (p value=0.021), annual treatment cost per patient (p value=0.001), health-related quality of life (HRQoL) (p value=0.004), and disability level (p value=0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment efect duration. It should also contribute to system sustainability by being afordable, it should have a positive impact on HRQoL, and it should prevent disability.
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    Challenges in diabetic macular edema management: an expert consensus report
    (Dove Medical Press Limited, 2021) Udaondo, P. (Patricia); Adan, A. (Alfredo); Arias-Barquet, L. (L.); Ascaso, F.J. (Francisco J.); Cabrera-López, F. (Francisco); Castro-Navarro, V. (Verónica); Donate, J. (Juan); Garcia-Layana, A. (Alfredo); Lavid, F.J. (Francisco Javier); Rodríguez‑Maqueda, M. (Mariano); Ruiz-Moreno, J.M. (José María)
    Purpose: This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel. Methods: A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients. Results: Panel was mainly focused on therapeutic objectives in DME management; defini tion terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors. Conclusion: This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients