Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization

Ophthalmology. 2000 Jul;107(7):1374-80. doi: 10.1016/s0161-6420(00)00169-x.


Objective: To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization.

Design: Computer-based econometric modeling.

Methods: The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money.

Database: Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis.

Intervention: Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration.

Main outcome measure: Cost per quality-adjusted life-year ($/QALY gained) associated with laser therapy.

Results: Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant $/QALY gained was $5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a $/QALY gained of $4974 with no gained discount rate and $11,633 with a yearly discount rate of 10%.

Conclusions: The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Choroidal Neovascularization / economics*
  • Choroidal Neovascularization / surgery
  • Cost-Benefit Analysis*
  • Decision Support Techniques
  • Fovea Centralis*
  • Health Status
  • Humans
  • Laser Coagulation / economics*
  • Markov Chains
  • Models, Econometric
  • Quality of Life
  • Visual Acuity