The Cost-Effectiveness of Photodynamic Therapy for Fellow Eyes With Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Ophthalmology. 2001 Nov;108(11):2051-9. doi: 10.1016/s0161-6420(01)00764-3.

Abstract

Purpose: Photodynamic therapy (PDT) has recently been demonstrated to be beneficial for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). Herein, we determine the cost-effectiveness of PDT for the treatment of subfoveal choroidal neovascularization (CNV) in patients with disciform degeneration in one eye and whose second and better-seeing eye develops visual loss secondary to predominantly classic subfoveal CNV. The analysis was performed from the perspective of a for-profit third-party insurer.

Design: Cost-utility Markov models were created to determine the cost-effectiveness of PDT under two different scenarios, by using efficacy data derived from the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study and patient-based utilities.

Methods: Decision analyses were performed by incorporating data from the TAP Study, expected longevity data, and patient-based utilities. Cost-effective models were then created by incorporating incremental medical costs. Various sensitivity analyses were carried out to determine the robustness of our models. A Monte Carlo simulation was also used to determine whether there was a significant difference in quality-of-life adjusted years (QALYs) gained between PDT therapy and the placebo.

Results: For the hypothetical patient whose second and better-seeing eye becomes affected and who has 20/40 vision at baseline in this affected eye (base case 1), PDT was associated with a 10.7% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0.1342 QALYs over a 2-year period). For the hypothetical patient whose second and better-seeing eye becomes affected and who has 20/200 vision at baseline in this affected eye (base case 2), PDT was associated with a 7.8% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0.0669 QALYs over a 2-year period). Sensitivity analysis showed our models were robust and that PDT was usually the dominant treatment choice. Our cost-effective model demonstrated that the cost for a QALY was $86,721 (US dollars discounted at 3%) for base case 1, assuming 5.5 treatments; and $173,984 (USD discounted at 3%) for base case 2.

Conclusions: PDT will cost a third-party insurer $86,721 for an AMD patient with 20/40 vision in the better-seeing eye to obtain one QALY and $173,984 for an AMD patient with 20/200 vision in the better-seeing eye to obtain one QALY. PDT can be considered to be a treatment that is of only minimal cost-effectiveness for AMD patients who have subfoveal CNV in their second and better-seeing eyes and who have good presenting visual acuity at baseline. It is a cost-ineffective treatment for AMD patients who have poor visual acuities in their affected better-seeing eyes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Choroidal Neovascularization / drug therapy
  • Choroidal Neovascularization / economics*
  • Choroidal Neovascularization / etiology
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Fovea Centralis / blood supply
  • Humans
  • Macular Degeneration / complications
  • Macular Degeneration / economics*
  • Markov Chains
  • Models, Econometric
  • Monte Carlo Method
  • Photochemotherapy / economics*
  • Photosensitizing Agents / economics
  • Photosensitizing Agents / therapeutic use
  • Quality-Adjusted Life Years
  • Visual Acuity

Substances

  • Photosensitizing Agents