Abstract
Purpose: :
Neovascular age-related macular degeneration secondary to 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 (PC). However, more recently, anti-vascular endothelial growth factor (VEGF) therapy (pegaptanib-Macugen® and ranibizumab-Lucentis® ) has also been shown to be effective with pegaptanib slowing progression, and ranibizumab improving visual acuity in some patients. We examine the cost-effectiveness of these treatments for AMD.
Methods: :
We constructed a Markov decision analytic model and evaluated using a microsimulation approach. The model was populated with data from the TAP, VISION, ANCHOR, and MARINA trials. As PDT has been show to be effective in treatment of 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 influence of changes in model parameters was evaluated using one-way sensitivity analysis and Monte Carlo simulation.
Results: :
In the model for treatment of PC lesions only, the improved visual acuity from treatment with ranibizumab resulted in an average gain of 0.42 quality-adjusted life years (QALYs) coming at a cost of $112,950 over their lifetime (above the cost of PDT), yielding in an ICER of $267,761/QALY when compared to PDT. In the any CNV lesion model, the treatment with ranibizumab resulted in a gain 0.52 QALYs over the average patient's lifetime at cost, $110,568, yielding an ICER of $212,580/QALY. In sensitivity analysis, only the cost of ranibizumab and the change in visual acuity following treatment were found to result in a change in the cost-effectiveness decision.
Conclusions: :
Of the three treatments for neovascular macular degeneration examined (i.e., PDT, pegaptanib, and ranibizumab), only ranibizumab results in improvement of visual acuity and quality of life. However, our analyses indicate that the premium required for this medication exceeds most commonly accepted standards of cost-effectiveness.
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • computational modeling