June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Comparing Prednisone and Methotrexate to Off-label Infliximab for the Management of Posterior Uveitis and Panuveitis: A Cost-Effectiveness Analysis
Author Affiliations & Notes
  • William V Padula
    Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, BALTIMORE, Maryland, United States
  • Taygan Yilmaz
    Department of Ophthamology, Brown University, Providence, Rhode Island, United States
  • Miguel Cordero-Coma
    Uveitis Unit, University Hospital of León, León, Spain
    Instituto de Biomedicina (IBIOMED), University of Leon, León, Spain
  • Michéal J Gallagher
    Department of Ophthamology, Hermitage Medical Clinic, Dublin, Ireland
  • Michael E Migliori
    Department of Ophthamology, Brown University, Providence, Rhode Island, United States
  • Footnotes
    Commercial Relationships   William Padula, None; Taygan Yilmaz, None; Miguel Cordero-Coma, None; Michéal Gallagher, None; Michael Migliori, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 509. doi:
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      William V Padula, Taygan Yilmaz, Miguel Cordero-Coma, Michéal J Gallagher, Michael E Migliori; Comparing Prednisone and Methotrexate to Off-label Infliximab for the Management of Posterior Uveitis and Panuveitis: A Cost-Effectiveness Analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):509.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Approximately 3.75% of cases of blindness in the U.S. are caused by uveitis. Incurred clinical costs and lost productivity related to vision loss totals $3.58 billion annually. We evaluated whether infliximab, a modern off-label biologic, is cost-effective for treating posterior uveitis and panuveitis compared to current standards of care, methotrexate and prednisone.

Methods : A cost-effectiveness analysis was performed using a Markov model to simulate a patient cohort with posterior uveitis or panuveitis. The model followed patients’ therapy from onset of posterior uveitis or panuveitis from the U.S. societal perspective. The lifetime model simulated health states that could lead to successful reversal of uveitis with standard or intensified treatment with prednisone, methotrexate, or infliximab. Probabilities, health utilities, and costs were included in the model based on published literature. We conducted univariate sensitivity analyses and a Bayesian multivariate probablistic sensitivity analysis to estimate uncertainty. Outcomes were measured in terms of costs ($US, 2010) and effects (quality-adjusted life years; QALYs), discounted at 3%/year. An incremental cost-effectiveness ratio (ICER) for pairwise results was interpreted assuming a predetermined willingness-to-pay threshold of $100,000/QALY.

Results : Average lifetime costs and QALYs fwere ($306.95; 15.80 QALYs) for prednisone, methotrexate ($36,232.24; 16.21 QALYs), and inflixmab ($74,762.63; 15.04 QALYs). Methotrexate was on average compared to prednisone, with an ICER of $86,901.16/QALY. Prednisone and methotrexate dominated infliximab. Sensitivity analyses suggested that the model was most sensitive to the utility for successful recovery from uveitis. The probabilistic sensitivity analysis returned results similar to the base case.

Conclusions : This cost-effectiveness analysis suggests that despite advances in the use of biologics for treating sight-threatening posterior uveitis and panuveitis, infliximab had lower effectiveness and higher costs compared to both prednisone and methotrexate. As compared to prednisone, methotrexate was associated with increased costs and QALYs and was found to be a good value. Clinical trials of infliximab in the uveitis population are needed to reduce the uncertain estimates of inflixmab treatment success and the drug’s cost-effectiveness.

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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