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E. Fletcher, V. Chong; Cost-analysis for Treatment of Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):725.
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Using a computer mathematical model to evaluate cost differentials on different drugs depending on drug cost, treatment frequency, and serious adverse event.
Computer mathematical model on numerous scenarios.
Scenario 1: Drug A and Drug L have similar efficacy and treatment frequency, but Drug A has an 1% increase of non-lethal stroke. If both drugs need 6 injections per year, the drug cost differential between them is $2000 per injection, hence $12,000 per year. The saving of treating 100 patients would be $1.2 million. However, there would be one extra non-lethal stroke. Looking after a non-lethal stroke individual has an estimated to cost $200,000 per year; so if the if the life expectancy is more than 6 years, there would have no monetary saving for the society, let alone the human suffering.Scenario 2: Drug V and Drug L have similar efficacy and similar adverse events but Drug V needs 4 treatments per year and 2 monthly follow up while Drug L needs 6 treatments per year but monthly follow up. By adding the cost of the visit, the cost of the injection into the mathematical model, if Drug L costs $2000, then Drug V can be charging $3400 to be equal in cost.Scenario 3: Drug V and Drug L have similar adverse events but Drug V needs 4 treatments per year and 2 monthly follow up while Drug L needs 6 treatments per year but monthly follow up. However, Drug V is on average 5 letters worse in terms of efficacy. Combining the data on our previously published QALY mathematical model (Ref), Drug V is still as cost-effective as Drug L if it costs $1600.
Drug pricing, efficacy, treatment frequency and the cost of managing adverse event can alter the cost-effectiveness of various treatments of a chronic condition such as age-related macular degeneration.Ref: Fletcher EC, Lade RJ, Adewoyin T, Chong NV. Computerized model of cost-utility analysis for treatment of age-related macular degeneration. Ophthalmology. 2008 Dec;115(12):2192-8.
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