Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases (E-PsEYE) who receive intra-ocular anti-VEGF injections: RCT (WC2016-048)


Starting date: 15/12/2016

Retinal exudative diseases are the leading cause of vision loss in older adults. They cause pathologically changed, and newly formed blood vessels to leak and damage the retina, reducing vision. There is no cure for these diseases, but pharmacological inhibition of the vascular endothelial growth factor (VEGF) in the eye can have a beneficial effect. Anti-VEGF drugs are injected into the eye at various intervals. In approximately one third of cases these injections lead to substantial improvement in vision. However, about one third will perceive further vision loss despite treatment, and the effects vary strongly between patients.

The uncertainty of progressive vision loss and the effectiveness of anti-VEGF injections can have a great impact on the psychological well-being of patients. Research shows that approximately one in three patients experience mild symptoms of depression and/or anxiety. These symptoms are the most important predictors of developing a DSM-V depressive or anxiety disorder and can lead to increased vision-specific disability, decreased health-related quality of life, and increased mortality.

To support patients in dealing with these symptoms, a cognitive behavioural therapy (CBT)-based e-mental health intervention was developed (called E-PsEYE). This intervention is expected to be cost-effective, since it is accessible (i.e., patients can use it at home), patient empowerment is stimulated, and relatively little effort from professionals is needed.

A randomised controlled trial (n=160), under supervision of Dr. Hilde van der Aa from the Low Vision Research group at the Ophthalmology department VUmc, will be performed to determine the cost-effectiveness of this intervention. Patients from five participating Dutch hospitals will use E-PsEYE at home, supported online by social workers from Royal Dutch Visio (low vision rehabilitation organisation).The project is financed by ZonMw Doelmatigheid and has a time period of 30 months (starting date 15 December 2016).