PSS10 Economical Burden of Severe Visual Impairment and Blindness – a Systematic Review

Abstract

OBJECTIVES:The use of intravitreal injection of vascular endothelial growth factor inhibitors is an effective treatment for AMD and trials have showed similar clinical effects of bevacizumab and ranibizumab. The aim of this study was to estimate the budget impact for Brazilian Ministry of Health (MoH) recommending ranibizumab instead of bevacizumab for AMD. METHODS: We did a deterministic budget impact analysis, with the MoH perspective, comparing the use of ranibizumab and bevacizumab for wet AMD. The target population was estimated by extrapolating epidemiologic data to the Brazilian population. Data about dosage, administration and fractioning were extracted from literature. Prices were obtained with the Brazilian regulatory agency, applying potential discounting benefits. This analysis did not consider the cost of the fractioning process because it will be assumed by the states and not by the MoH. RESULTS: The considered price of the ranibizumab vial was OBJECTIVES: Psoriasis is a chronic disease that impacts significantly on patients' quality of life (QoL). Biological drugs interfere in the immunologic process that triggers and supports psoriasis and, therefore, prove effective in its treatment. The aim of this study was to perform a cost-utility analysis (CUA) comparing biologic treatments (adalimumab, etanercept, infliximab, and ustekinumab) in Italy. METHODS: A decision tree model previously applied to the UK was adapted for Italy using resource and cost data from the Italian Ministry of Health (Ministero della Salute). Clinical efficacy in the treatment of moderate to severe psoriasis was determined by the Psoriasis Area Criteria and Severity Index (PASI). Relative efficacy of biologic treatments was based on a network meta-analysis of clinical trials. A different level of utility is associated with each level of PASI response. Costs included hospitalization, drug acquisition, administration, and monitoring over a 10-year time horizon. Incremental cost-effectiveness ratios (ICERs) compared with supportive care (no systemic therapy) were expressed as euros/quality-adjusted life year (QALY). One-way sensitivity analyses, where key parameters were changed to alternative plausible values, explored uncertainty in the results. RESULTS: In the base case, adalimumab was found to be the most cost effective compared to supportive care (ICER: €52,583), followed by ustekinumab 90 mg (ICER: €52,846), ustekinumab 45 mg (ICER: €54,997), infliximab (ICER: €56,141), etanercept 50 mg BIW (ICER: €77,611), and etanercept 25 mg BIW (ICER: €78,194). The ICER for ustekinumab 90 mg, ustekinumab 45mg, and infliximab compared to adalimumab were €57,052, €140,445, and €86,794, respectively. Adalimumab remained the most cost-effective over the vast majority of the one-way sensitivity analyses. CONCLUSIONS: The analysis demonstrated that adalimumab is the most costeffective biologic for the treatment of patients affected by moderate to severe psoriasis. OBJECTIVES:Treatment strategies for the prevention of macular oedema (MO) in di...