Pharmacologic management of neovascular age-related macular degeneration: Systematic review of economic evidence and primary economic evaluation

William Hodge, Allan Brown, Steve Kymes, Alan Cruess, Gord Blackhouse, Robert Hopkins, Lynda McGahan, Sanjay Sharma, Irene Pan, Jason Blair, David Vollman, Andra Morrison

Research output: Contribution to journalReview article

19 Scopus citations

Abstract

Objective: To examine the economic implications for the Canadian health system of pharmacologic treatment of neovascular age-related macular degeneration (AMD). Design: Systematic review of economic literature and a primary economic evaluation. Participants: Economic literature search identified 392 potentially relevant articles, 12 of which were included for final review. Methods: Studies were included if they met the following criteria: (i) provision of a summary measure of the trade-off between costs and consequences; (ii) participants of 40 years and older with neovascular AMD; (iii) interventions and comparators: comparison of photodynamic therapy using verteporfin (V-PDT), pegaptanib, bevacizumab, ranibizumab, anecortave acetate, intravitreal triamcinolone, placebo, or clinically relevant combinations; and (iv) outcome reported as an incremental measure of the implication of moving from the comparator to the intervention. The following databases were searched through the OVID interface: MEDLINE, EMBASE, BIOSIS Previews, CINAHL, PubMed, Health Economic Evaluations Database (HEED), and the Cochrane Library. For the economic evaluation, we took a decision analytic approach and modeled a cost-utility analysis, conducting it as a microsimulation of a Markov model. Results: In general, V-PDT is more cost effective than conventional macular laser, and pegaptanib is likely more cost effective than V-PDT. The primary economic analysis revealed ranibizumab to be effective but at an unacceptably high cost per quality-adjusted life year (QALY) (>$50 000 per QALY). Conclusion: Although ranibizumab is effective for wet AMD, its cost is unacceptably high based on cost-utility theory.

Original languageEnglish
Pages (from-to)223-230
Number of pages8
JournalCanadian Journal of Ophthalmology
Volume45
Issue number3
DOIs
StatePublished - Jun 2010

Keywords

  • Age-related macular degeneration
  • Cost effectiveness
  • Pharmacologic treatment
  • Quality-adjusted life year
  • Systematic review

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    Hodge, W., Brown, A., Kymes, S., Cruess, A., Blackhouse, G., Hopkins, R., McGahan, L., Sharma, S., Pan, I., Blair, J., Vollman, D., & Morrison, A. (2010). Pharmacologic management of neovascular age-related macular degeneration: Systematic review of economic evidence and primary economic evaluation. Canadian Journal of Ophthalmology, 45(3), 223-230. https://doi.org/10.3129/i10-047