June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Comparison of treatment cost and quality-of-life impact of thyroid eye disease therapies
Author Affiliations & Notes
  • Shreya Ashish Shah
    Stanford University School of Medicine, Stanford, California, United States
  • Tracy Lu
    Stanford University School of Medicine, Stanford, California, United States
    Department of Ophthalmology, Stanford Medicine, Stanford, California, United States
  • Michael Yu
    Stanford University School of Medicine, Stanford, California, United States
    Department of Ophthalmology, Stanford Medicine, Stanford, California, United States
  • Susan Hiniker
    Department of Radiation Oncology, Stanford Medicine, Stanford, California, United States
  • Chrysoula Dosiou
    Department of Endocrinology, Stanford Medicine, Stanford, California, United States
  • Andrea Lora Kossler
    Stanford University School of Medicine, Stanford, California, United States
    Department of Ophthalmology, Stanford Medicine, Stanford, California, United States
  • Footnotes
    Commercial Relationships   Shreya Shah None; Tracy Lu None; Michael Yu None; Susan Hiniker None; Chrysoula Dosiou Horizon Therapeutics, Code C (Consultant/Contractor); Andrea Lora Kossler Horizon Therapeutics, Code C (Consultant/Contractor)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4002 – A0344. doi:
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      Shreya Ashish Shah, Tracy Lu, Michael Yu, Susan Hiniker, Chrysoula Dosiou, Andrea Lora Kossler; Comparison of treatment cost and quality-of-life impact of thyroid eye disease therapies. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4002 – A0344.

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

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Abstract

Purpose : Teprotumumab was approved as a treatment for thyroid eye disease (TED) in 2020, but some clinicians question whether its high cost is worth its benefits. Cost-effectiveness analyses (CEAs) can help answer this question, but the health utility scores required are rare in TED. In this study we compare costs of teprotumumab with other treatments and use the validated Graves’ orbitopathy quality-of-life (GO-QoL) score to measure change (Δ) in QoL. Our aim is to help clinicians think critically about treatment costs for TED as health care shifts to focus on cost-effective solutions.

Methods : Analysis was limited to first and second-line therapies for moderate-to-severe active TED (as per the 2021 European Group on Graves Orbitopathy guidelines) with pre- and post-intervention GO-QoL scores available in the literature. The costs of these treatments were obtained from the Turquoise Health database using Medicare billing codes. Prices were then generated from 1,903 hospitals in 50 states. Full treatment costs, including costs of medication and infusion, were calculated using recommended dosing guidelines and standardized to a 70kg patient (Table 1).

Results : Costs of teprotumumab, rituximab, orbital radiotherapy (ORT), and IV methylprednisolone (IVMP) were analyzed. Among these, teprotumumab had the highest mean treatment-related cost at $386,424 (SD $65,217) followed by rituximab at $18,549 (SD $2,556), ORT at $4,316 (SD $1,183), and IVMP at $4,025 (SD $1,647). Teprotumumab yielded a ΔGO-QoL of 19.4 (SD 18.8), rituximab 17.9 (single study), IVMP 13.5 (SD 25.2), and ORT 6.6 (SD 27.8). Treatment cost/ΔGO-QoL for teprotumumab was greatest at $19,888, followed by rituximab at $1,036, ORT at $651, and IVMP at $298 (Table 2).

Conclusions : Treatment cost/ΔGO-QoL of teprotumumab is nearly 20 times that of rituximab and around 50 times that of IVMP. Long-term data regarding the effect of teprotumumab on reducing the rates of orbital and strabismus surgery and improving ocular sequelae, as well as studies evaluating the impact of treatment on QoL using quality-adjusted life years, are needed to be able to determine the cost-effectiveness of the various treatment options for TED.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Table 1. Derivation of Total Costs for Each Treatment

Table 1. Derivation of Total Costs for Each Treatment

 

Table 2. Calculated Treatment Costs, Mean ΔGOQoL and Cost/ΔGOQoL

Table 2. Calculated Treatment Costs, Mean ΔGOQoL and Cost/ΔGOQoL

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