Purpose: To perform cost-utility analysis of ranibizumab, photodynamic therapy (PDT) and pegaptanib sodium treatment of neovascular age-related macular degeneration (AMD) with subfoveal choroidal neovascularization.
Materials and methods: The analyses were performed on a 75-year old man with the starting visual acuity of letter score of 50 on an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart, with the affected eye having better sight than the contralateral eye, for the time horizons of 1 and 11 year (s). Visual acuity data from the large controlled studies for ranibizumab, photodynamic therapy and pegaptanib sodium, were applied. The results were compared with best supportive care (BSC) data. Cost indications included direct medical costs and costs related with social blindness. Utility values were estimated from the time trade off method. This analysis was performed from a societal perspective.
Results: In the 1-year model, cost of treatment was dominant in the treatment groups, whereas the cost of blindness was dominant in the BSC. In the 11-year model, influence of cost of blindness resulted in the increasing costs for BSC. Of note, ranibizumab and PDT were less costly and showed an increase in utility compared to the BSC. Pegaptanib sodium was found to be costly. Sensitivity analysis found that the results were robust to changes in various model parameters.
Conclusion: In the current model, ranibizumab and PDT confer quality-adjusted life years (QALY) gains and are less costly compared to BSC in the lifetime treatment. In contrast, pegaptanib sodium treatment could be considered to be of minimal cost-effectiveness. Ranibizumab and PDT confer excellent value in the models of the lifetime treatment.