A Value-Based Medicine Comparison of Interventions for Subfoveal Neovascular Macular Degeneration

Brown, Gary C.; Brown, Melissa M.; Brown, Hilary F.; Kindermann, Sylvia L.; Sharma, Sanjay

doi:10.1016/j.ophtha.2006.09.019

Cited by 72 publications

(56 citation statements)

References 21 publications

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“…Costs per QALY gained for laser photocoagulation compared with no treatment or with observation were $US5629-23 176 over time horizons of 11-14 years (table III). [10][11][12] …”

Section: Cost Utilitymentioning

confidence: 99%

“…[11,15] A Canadian HTA evaluated PDT from a societal perspective over an 8-year timeframe, and also judged it to be cost effective (<$Can50 000) both for predominantly classic CNV and for classic and occult CNV; [13] however, Sharma et al [19] evaluated PDT from a third-party payer's perspective using 1-to 2-year TAP data and found PDT to be of poor-tomodest cost effectiveness based on an 11-year timeframe.…”

Section: Cost Utilitymentioning

confidence: 99%

“…PDT was found to be more likely to be cost effective when given early in the course of the disease to patients with better visual acuity; a study using a 7-year evaluation period in an Australian setting [17] and a 5-year period in the UK [20] both showed that PDT was borderline cost effective versus placebo for patients with 'reasonable' initial visual acuity (6/12 [20/40] Healthcare system and Personal Social Services; 1 y of tx (predominantly classic CNV); 2 y of tx (minimally classic CNV); 1-to 2-and 10-y timeframes (BSC) 12 over 1 y (predominantly classic CNV); 24 over 2 y (minimally classic CNV) Neubauer et al, [27] Germany, h, NR Societal; 2 y of tx; 10-y timeframe (BSC) Brown et al, [11] $US 2 012 0.246 8 179…”

Section: Cost Utilitymentioning

confidence: 99%

See 2 more Smart Citations

Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

et al. 2011

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“…Costs per QALY gained for laser photocoagulation compared with no treatment or with observation were $US5629-23 176 over time horizons of 11-14 years (table III). [10][11][12] …”

Section: Cost Utilitymentioning

confidence: 99%

Section: Cost Utilitymentioning

confidence: 99%

Section: Cost Utilitymentioning

confidence: 99%

See 1 more Smart Citation

Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

et al. 2011

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“…Within study (TT Chan et al [38] Screening Dakin et al [41] Ranibizumab and bevacizumab for AMD United Kingdom Within study (EQ Elshout et al [42] Aflibercept for AMD Netherlands Within study (H Butt et al [43] Bevacizumab for AMD United Kingdom Espallargues 200…”

Section: Chinamentioning

confidence: 99%

Health State Utility Values for Age-Related Macular Degeneration: Review and Advice

Butt

Tufail

Rubin

2016

Appl Health Econ Health Policy

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Health state utility values are a major source of uncertainty in economic evaluations of interventions for age-related macular degeneration (AMD). This review identifies and critiques published utility values and methods for eliciting de-novo utility values in AMD. We describe how utility values have been used in health care decision making and provide guidance on the choice of utility values for future economic evaluations for AMD. Literature was searched using PubMed and health technology assessments (HTA) were searched using HTA agency websites to identify articles reporting utility values or approaches to derive utility values in AMD and articles applying utility values for use in health care decision making.s71 studies qualified for data extraction of which 22 were classified as containing utility values and/or elicitation methods relevant to AMD, while 49 were classified as using utility values in decision-making. A large number of studies have elicited utility values for AMD, although those applied to decision making have focused on a few of these. There is an appreciation of the challenges in the measurement and valuation of health states, with recent studies addressing challenges such as the insensitivity of generic health-related quality of life (HRQoL) questionnaires and utility in the worse seeing eye. We would encourage careful consideration when choosing utility values in decision making and an explicit critique of their applicability to the decision problem. Key Points for Decision Makers: There is a large body of literature describing utility values in AMD. Cost-utility analysis has been widely used to assess relative value of these interventions. A recent review of economic models comparing treatments for AMD identified 36 studies of which all but 3 reported costs per quality-adjusted life year (QALY). [2] QALYs are calculated by weighting each year of life lived using a utility score. Utility scores are anchored so that 1 is perfect health and 0 is equivalent to the state of death. Multiplying time in a health state by the health state utility value, 1 year of life lived in perfect health is equal to 1 QALY.[3]The term 'utility' in cost-utility analysis and its theory is based on von NeumannMorgenstern (vN-M) utility theory. The normative model for utility theory, the model for how a rational individual ought to behave, is that utility scores represent the strength of an individual's preference when faced with uncertainty for a given outcome, in this case a health state. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) scheme (Table 1) illustrates the included studies after title/abstract and full text reviews. Of the 206 studies identified, 113 studies were excluded after review of abstracts and titles. Reasons for exclusion included the topic not relating to utility, the disease not covering AMD, there being no primary data (e.g. letter or review) and the language not being English. After full text review, a further 23 studies were excluded due to the...

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“…La qualità della vita associata alla metamorfopsia è la stessa, indipendentemente dal sottogruppo ed è stata associata ai pazienti la cui VMT è rimasta irrisolta, o il MH aperto. La rottura della retina e l'aumento della pressione intraoculare sono stati considerati come costi e ad essi è stato associato un valore di disutilità, ricavato dai dati disponibili in letteratura [19][20][21]. Le disutilità sono state normalizzate per la durata di un ciclo ad eccezione della metamorfopsia che può persistere fino a risoluzione della VMT o chiusura del MH.…”

Section: Costiunclassified

[Cost-effectiveness analysis of ocriplasmin in the treatment of vitreomacular traction in Italy]

D’Angiolella

Miglietta

Bandello³

et al. 2015

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ne dell'architettura retinica e possibile formazione di un foro maculare (Macular Hole -MH), con conseguente riduzione dell'acuità visiva (Visual Acuity -VA) , metamorfopsia e fotopsia [1][2][3][4]. Solo negli ultimi anni, grazie allo sviluppo della Tomografia a Coerenza Ottica (Optical Coherence Tomography -OCT) è stato possibile documentare strumentalmente ed in maniera accurata l'evoluzione della patologia e comprenderne meglio i meccanismi fisiopa- IntroduzIoneLa trazione vitreomaculare (VitreoMacular Traction -VMT) rappresenta una condizione patologica che si può instaurare quando il corpo vitreo, con l'invecchiamento, tende a liquefarsi e a ridursi in volume, con successivo fisiologico distacco dalla superficie retinica. Un distacco parziale, con adesione residua tra vitreo e macula, può esercitare una trazione sulla macula sottostante (chiamata trazione vitreomaculare), causando distorsio- Corresponding authorLucia Sara D'Angiolella lucia.dangiolella@ fondazionecharta.org DisclosureThis study was funded by an unconditional grant from Alcon Italia S.p.A. AbstrActBACKGROUND: Vitreomacular traction (VMT) caused by vitreomacular adhesion (VMA), is a pathological condition when the vitreous humor has an abnormally strong attachment to the central part of the retina. Ocriplasmin recently approved for the treatment of VMT, including when associated with macular hole (MH) of diameter less than or equal to 400 microns, is a recombinant truncated form of the human serine protease plasmin with retained enzymatic activity, administered by intravitreal injection. We estimated long-term benefits and costs associated with the resolution of traction, following treatment with ocriplasmin versus Standard of Care (SoC), from National Health Service (NHS) perspective. METHODS: A lifetime Markov model has been adopted for Italy in order to estimate costs and outcomes, gained for patients with VMT, with and without MH, treated with ocriplasmin. Health effects have been expressed as Life Years (LY) and Quality adjusted LY gained (QALY), and estimated based on time spent in Visual Acuity (VA) states, defined by best and worst seeing eye, disutility impact associated with surgical interventions, adverse events and metamorphopsia. Deterministic and probabilistic analysis have also been conducted. RESULTS: Over a lifetime ocriplasmin versus SoC generated incremental benefits in terms of QALYs and overall treatment costs in each patients subgroups. Patients with VMT and VMT+MH treated with ocriplasmin had an incremental survival benefits of 0.1123 and 0.0772 QALYs respectively. Therefore, it is expected to come at an incremental cost of 1,873 € and 2,185 € for VMT and VMT+MH patients respectively. The associated ICER is 16,683 € and 28,294 € per QALY gained. Both sensitivity analyses for each of the subgroups confirmed the robustness of the model results. CONCLUSION: Compared to SoC, ocriplasmin is a cost effective therapy option in the treatment of VMT, including when associated with MH.

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A Value-Based Medicine Comparison of Interventions for Subfoveal Neovascular Macular Degeneration

Cited by 72 publications

References 21 publications

Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

Health State Utility Values for Age-Related Macular Degeneration: Review and Advice

[Cost-effectiveness analysis of ocriplasmin in the treatment of vitreomacular traction in Italy]

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