Abstract
Purpose:
To assess cost-effectiveness (CE) of anti-VEGF treatment for neovascular age-related macular degeneration (nv AMD) from a healthcare payer’s perspective, using long-term data from routine medical practice in Australia.
Methods:
200 patients undergoing long-term (>1 year) anti-VEGF treatment for nvAMD were included and costs for services assigned based on Medicare Australia rebates. Three Markov models (MM) were created to reflect impact of anti-VEGF treatment on 1. better eye and 2. treated eye VA and 3. vision states combining both eye VA using TreeAge software, based on our real life data. Vision-related utilities were based on a large (n>1300) reference sample interviewed using the Vision and Quality of Life multi-attribute utility instrument. Costs and rewards were discounted at 3.5%/year and final results tested in probabilistic sensitivity analyses.
Results:
Mean treatment duration was 37 (±13) months and mean injections were 21(±11;7 in year 1-3, 6 in year 4, 5 in year 5). VA in the treated eye improved from baseline to last follow-up (+7 ltrs; 49 to 56 ltrs, p<0.001) and remained stable in the better eye (-3 ltrs; 66 to 63 ltrs, p=0.001). 40% of patients were treated in both eyes during year 1, and 50% by year 5. Treatment costs were highest in the first year (A$18,296 ± 7,991), and lower for uniocular (A$16,123±6,757) than for binocular treatment ($21,487±8,610). Based on these data MMs ran for 5 years, with all treatment assumed to be with ranibizumab (A$ 1976.36). Cost-effectiveness was A$17,155/QALY for better eye, 17,812/QALY for treated eye and 17,243/QALY for both eye vision state models, with the both eye vision state MM generating most QALYs (1.80 compared to 1.74 in MM1 and 1.70 in MM2).
Conclusions:
All modeling approaches arrived at CE estimates well below the cut-off of $50,000/QALY commonly accepted to be cost-effective. Using treated eye VA led to a low estimate of treatment effects and high costs, whereas using better eye VA led to a medium estimate of treatment effect and the lowest cost. Using both eyes’ VA (in vision states) most accurately reflects clinical reality with a necessity to treat both eyes in a considerable proportion of patients and led to the highest estimate of treatment impact with a medium cost estimate. Economic evaluations of bilateral ocular disease and its treatments should take both eyes’ VA into account.
Keywords: 412 age-related macular degeneration •
460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower