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D. Vollman, S. M. Kymes, M. A. Brantley; Cost-Effectiveness of Treatment of Neovascular Age-Related Macular Degeneration in the United States: A Cost-Utility Study Using a Microsimulation Approach. Invest. Ophthalmol. Vis. Sci. 2009;50(13):273.
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Neovascular age-related macular degeneration (AMD), also called choroidal neovascularization (CNV), is the leading cause of blindness in the United States and most developed nations. Photodynamic therapy (PDT) has been shown to slow progression in people with predominantly classic CNV. More recently, anti-VEGF therapy has also been shown to be effective with pegaptanib (Macugen®) slowing progression, and ranibizumab (Lucentis®) reversing the disease process in some patients. We examine the cost-effectiveness of these treatments for AMD using standards of care in vitreoretinal practice in the United States.
We constructed a Markov decision analytic model and evaluated the model using a microsimulation approach. The model was populated with data from the TAP, VISION, ANCHOR, and MARINA trials. As PDT is only approved for use in people with PC lesions, we examined treatment of people with PC lesions in one model, and treatment of those with any lesion separately. The model for treatment of PC lesions compared treatment with PDT, pegaptanib, and ranibizumab; and the second considered only pegaptanib and ranibizumab. We report the incremental cost-effectiveness ratios (ICER) for both models.
The improved efficacy of ranibizumab results in an average gain of 0.78 QALYs for people with PC lesions coming at a cost of $69,000 over the same lifetime (above the cost of Macugen), resulting in an ICER of $88,462/QALY when compared to Macugen. In the any CNV lesion model, the superior efficacy of ranibizumab again results in a gain in lifetime QALYs, 1.16. However, this gain again comes at a relatively high cost, $96,000, resulting in an ICER of $82,759/QALY.
Of the three available treatments for neovascular macular degeneration, only ranibizumab results in a reversal of the degenerative process. However, our analyses indicate that the premium required for this medication exceeds most commonly accepted standards of cost-effectiveness.
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