The cost-effectiveness of the Argus II retinal prosthesis in Retinitis Pigmentosa patients

Abstract

BackgroundRetinitis Pigmentosa (RP) is a hereditary genetic disease causing bilateral retinal degeneration. RP is a leading cause of blindness resulting in incurable visual impairment and drastic reduction in the Quality of life of the patients. Second Sight Medical Products Inc. developed Argus II, a retinal prosthesis system for treating RP. Argus II is the world’s first ever-commercial implant intended to restore some vision in the blind patients. The objective of this study was to assess the cost-effectiveness of the Argus® II Retinal Prosthesis System (Argus II) in Retinitis Pigmentosa (RP) patients.MethodA multi -state transition Markov model was developed to determine the cost-effectiveness of Argus II versus usual care in RP from the perspective of healthcare payer. A hypothetical cohort of 1000 RP patients aged 46 years followed up over a (lifetime) 25-year time horizon. Health outcomes were expressed as quality adjusted life years (QALYs) and direct healthcare costs expressed in 2012 €. Results are reported as incremental cost per ratios (ICERs) with outcomes and costs discounted at an annual rate of 3.5%.ResultsThe ICER for Argus II was €14,603/QALY. Taking into account the uncertainty in model inputs the ICER was €14,482/QALY in the probabilistic analysis. In the scenarios of an assumption of no reduction on cost across model visual acuity states or a model time horizon as short as 10 years the ICER increased to €31,890/QALY and €49,769/QALY respectively.ConclusionThis economic evaluation shows that Argus II is a cost-effective intervention compared to usual care of the RP patients. The lifetime analysis ICER for Argus II falls below the published societal willingness to pay of EuroZone countries.

Electronic retinal implants and artificial vision: journey and present

“…The economic case for the Argus II prosthesis was analysed by Vaidya et al 64 in 2014. They used a theoretical cohort of 1000 RP patients that were aged 46 and followed up over 25 years and applied a Markov model.…”

“…If the devices only last 10 years, the lifespan of which is not yet determined in real-world implantation, the ICER increases to~€50 000/QALY assuming over time cost reductions. 64 Despite this, the Argus II device is forecast to be a cost-effective device and within the ICER limit for most European countries.…”

Improving training for sensory augmentation using the science of expertise

“…Retinal implants involve inserting an electrode array that stimulates the retina according to the luminance of a detected scene, in a similar way to SSADs translating a scene; the stimulation produces phosphenes, and the experience can be used to navigate (for a review of the progress of retinal implants see Dagnelie (2012)). Implants can be expensive (Vaidya et al, 2014), and due to the risk of additional damage, invasive implants are typically used in extreme cases of impairment (Striem-Amit et al, 2012b). In contrast, SSADs can be used regardless of aetiology with little risk.…”

Chapter 1 - Restoring Vision to the Blind: The New Age of Implanted Visual Prostheses

“…Furthermore, in quantifying regained independence and connectedness and integrating them with more traditional measures of visual function, the goal should be to facilitate cost-benefit analyses such as the quality-adjusted life year (QALY) for use by individuals, clinicians, insurers, researchers, governments, and research funding agencies. For general information on how the usefulness of medical interventions is evaluated, see Fanshel & Bush, 1970;Pliskin, Shepard, & Weinstein, 1980; for specific evaluations of implantable visual prostheses, see Vaidya et al, 2014;Wrobel, 2010, as an example. The final monetary and societal value of an implant device will be a deciding factor in whether it can prove viable either as a commercial venture or as a humanitarian/societal endeavor.…”