TY - JOUR
T1 - Pharmacologic management of neovascular age-related macular degeneration
T2 - Systematic review of economic evidence and primary economic evaluation
AU - Hodge, William
AU - Brown, Allan
AU - Kymes, Steve
AU - Cruess, Alan
AU - Blackhouse, Gord
AU - Hopkins, Robert
AU - McGahan, Lynda
AU - Sharma, Sanjay
AU - Pan, Irene
AU - Blair, Jason
AU - Vollman, David
AU - Morrison, Andra
N1 - Funding Information:
*One author is listed as an employee of Pfizer and another works for an organization that has received funding from Pfizer. {Includes NHS costs as well as personal social service costs. {Includes other NHS costs besides treatment costs, plus personal social service costs. Note: PDT, photodynamic therapy; QALY, quality-adjusted life year; NHS, National Health Service (UK); BSC, best supportive care.
Funding Information:
This study was supported by the Canadian Agency for Drugs and Technologies in Health. The authors thank Francie Si, MD, MSc, Ivey Eye Institute, University of Western Ontario, for proofreading and editing citations, references, and tables, and for assistance with collection of copyright/authorship forms and submission. The authors have no proprietary or commercial interest in any materials discussed in this article.
PY - 2010/6
Y1 - 2010/6
N2 - 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.
AB - 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.
KW - Age-related macular degeneration
KW - Cost effectiveness
KW - Pharmacologic treatment
KW - Quality-adjusted life year
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=77953310762&partnerID=8YFLogxK
U2 - 10.3129/i10-047
DO - 10.3129/i10-047
M3 - Review article
C2 - 20628420
AN - SCOPUS:77953310762
SN - 0008-4182
VL - 45
SP - 223
EP - 230
JO - Canadian Journal of Ophthalmology
JF - Canadian Journal of Ophthalmology
IS - 3
ER -