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

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      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 forfinal 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) (>$50000 per QALY).
      Conclusion: Although ranibizumab is effective for wet AMD, its cost is unacceptably high based on cost-utility theory.


      Objet: Examen des implications economiques du mode de traitement pharmacologique de la dégénérescence maculaire néovasculaire liée à l’âge (DMLA), dans le système de santé canadien.
      Nature: Un examen systématique de la littérature économique et une évaluation économique primaire.
      Participants: La recherche dans la littéerature économique a permis d'identifier 392 articles potentiellement pertinents; 12 ont été inclus dans la revue définitive.
      Methodes: Ces éetudes devaient respecter les critéres que voici: (i) provision d'une mesure sommaire de compromis entre les coûts et les consèquences; (ii) participants de 40 ans et plus avec DMLA néovasculaire; (iii) interventions et comparables: comparaison de la thèrapie photodynamique à l’aide de verteporfin (V-PDT), pégaptanib, bévacizumab, ranibizumab, acétate d'anecortave, triamcinolone intravitréen, placébo ou combinaisons cliniquement pertinentes; et (iv) résultats signalés comme mesures incrémentielles de l’implication du changement du comparable à l’intervention. Les bases de données qui suivent ont fait l’objet de la recherche par l’interface OVID: MEDLINE, EMBASE, BIOSIS Previews, CINAHL, PubMed, Health Economic Evaluations Database (HEED) et Cochrane Library. Aux fins de l’évaluation économique, nous avons pris une approche analytique décisionnelle et avons modélisé une analyse coût-utilité, sous forme de microsimulation d'un modèle de Markov.
      Résultats: En règle générale, le V-PDT est plus rentable que le laser maculaire conventionnel, et le pégaptanib est vraisemblablement plus rentable que le V-PDT. L’analyse économique primaire a révélé que le ranibizumab est plus efficace mais à un coût élevé inacceptable par année de vie qualité ajustee (QALY) (>50 000 $ par QALY).
      Conclusion: Bien que le ranibizumab soit efficace pour la DMLA humide, son coût élevé est théoriquement inacceptable sur une base de coût-efficacité.


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