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Patricio Gerardo Schlottmann, Jose D Luna Pinto, Santiago Palma, Juan Pablo Real; Use of discrete event simulation (DEM) to evaluate the clinical practices in neovascular age-related macular degeneration . Invest. Ophthalmol. Vis. Sci. 2017;58(8):428.
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To evaluate the outcomes and direct medical cost of different treatment regimens in managing nAMD.
A discrete event simulation model was developed reproducing the long-term evolution of 5000 patients with nAMD. The model allows calculation the cost-effectiveness of treatment of AMD with Ranibizumab in two different therapeutic regimens: pro re nata (PRN) and Treat and Extend (TAE). Ranibizumab at the price of Lucentis (U$2000) and Ranibizumab at the price of Accentix (U$380). Data on effectiveness, rate of visual loss without treatment,the vision-related quality of life, time with VEGF suppression and time to functional recurrence were identified through a systematic literature searches.Time horizons were 10 years. A third-party-payer perspective was employed. A discount rate of 3% per annum was considered for both costs and outcomes benefits.
Over ten years of simulated treatment show us that the use of TAE scheme implies a higher number of intravitreal doses, a smaller number of consultations and savings in the accomplishment of studies of OCT. Effectiveness associated with the RNB regimens, Treat and extend (TAE) and as-needed (PRN), were 4.83 and 4.71QALY, respectively. The cost associated with LUCENTIS TAE and PRN were U$149.722 and U$ 125.200. When the price of Ranibizumab is that of Accentix, the cost associated is U$56.540 and U$60.000. The sensitivity analysis shows that TAE can be considered cost-effective compared to PRN when the price of RNB is less than U$900.
DEM is a useful tool in the analysis of clinical practices For this case,TAE is the most effective régimen and is cost effective when Accentix is used.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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