Advertisement

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

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      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.

      Résumé

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Buhrmann R
        • Hodge W
        • Gold D
        Forecasting the vision loss epidemic in Canada current and projected estimates of age-related eye disease: interim summary tables prepared for the National Coalition on Vision Health. 2006
      1. Drugs & health products: notice of compliance. Health Canada, Ottawa, Ont.2000 (Available at) (Accessed January 10, 2008)
      2. Notice of decision for Macugen. Therapeutic Products Directorate, Health Canada, Ottawa, Ont.June 2, 2005 (Available at: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/ pdf/prodpharma/nd_ad_2005_macugen_094022_e.pdf. Accessed September 15, 2005.)
        • Drummond MF
        • Jefferson TO
        • BMJ Economic Evaluation Working Party
        Guidelines for authors and peer reviewers of economic submissions to the BMJ.
        BMJ. 1996; 13 (Available at) (Accessed February 19, 2007.): 275-283
        • Brown GC
        • Brown MM
        • Campanella J
        • Beauchamp GR
        The cost-utility ofphotodynamic therapy in eyes with neovascular macular degeneration-a value-based reappraisal with 5-year data.
        Am J Ophthalmol. 2005; 140: 679-687
        • Greiner RA
        Cost ofcare for patients with age-related macular degeneration in Switzerland and cost-effectiveness of treatment with verteporfin therapy.
        Semin Ophthalmol. 2001; 16: 218-222
        • Hopley C
        • Salkeld G
        • Mitchell P
        Cost utility of photodynamic therapy for predominantly classic neovascular age related macular degeneration.
        Br J Ophthalmol. 2004; 88: 982-987
        • Larouche K
        Photodynamic therapy for the treatment of exudative age-related macular degeneration (ARMD) with subfoveal neovascularization. Montr\'eal: Agence d'\'evaluation des technologies et des modes d'intervention en sant\'e (AETMIS)2004 (Available at) (Accessed February 28, 2007.)
        • Meads C
        Clinical effectiveness and cost-utility of photo-dynamic therapy for wet age-related macular degeneration: a systematic review and economic evaluation.
        Health Technol Assess. 2003; 7: v-vi
        • Meads C
        Clinical effectiveness and cost-utility of photo-dynamic therapy for wet age-related macular degeneration: a systematic review and economic evaluation.
        Health Technol Assess. 2003; 7 (Available at) (Accessed February 28, 2007.): 1-98
        • Sharma S
        • Brown GC
        • Brown MM
        • Hollands H
        • Shah GK
        The cost-effectiveness ofphotodynamic therapy for fellow eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration.
        Ophthalmology. 2001; 108: 2051-2059
        • Smith DH
        • Fenn P
        • Drummond M
        Cost effectiveness of photodynamic therapywith verteporfin for age related macular degeneration: the UK case.
        Br J Ophthalmol. 2004; 88: 1107-1112
        • Wolowacz SE
        • Roskell N
        • Kelly S
        • Maciver FM
        • Brand CS
        Cost effectiveness of pegaptanib for the treatment of age-related macular degeneration in the UK.
        Pharmacoeconomics. 2007; 25: 863-879
        • Raftery J
        • Jones J
        • Clegg A
        • Lotery A
        Ranibizumab (Lucentis) versus bevacizumab (Avastin): modellingcost effectiveness.
        Br J Ophthalmol. 2007; 91: 1244-1246
        • Sharma S
        • Bakal J
        • Sharma SM
        • Covert D
        • Shah GK
        Drug pricing for a novel treatment for wet macular degeneration: using incremental cost-effectiveness ratios to ensure societal value.
        Can J Ophthalmol. 2005; 40: 369-377
        • Javitt JC
        • Zlateva GP
        • Earnshaw SR
        • et al.
        Cost-effectiveness model for neovascular age-related macular degeneration: comparing early and late treatment with pegaptanib sodium based on visual acuity.
        Value Health. 2008; 11: 563-574
        • Earnshaw SR
        • Moride Y
        • Rochon S
        Cost-effectiveness of pegap-tanib compared to photodynamic therapy with verteporfin and to standard care in the treatment of subfoveal wet age-related macular degeneration in Canada.
        Clin Ther. 2007; 29: 2096-2106
        • Weinstein MC
        Recent developments in decision-analytic modelling for economic evaluation.
        Pharmacoeconomics. 2006; 24: 1043-1053
        • Drummond MF
        • BJ O’Brien
        • Stoddart GL
        • Torrance GW
        Methods for the Economic Evaluation ofHealth Care Programmes. 2nd ed. Oxford University Press, New York, N.Y.1997
        • Markovitz JH
        • Roubin GS
        • Parks JM
        • Bittner V
        Platelet activation and restenosis after coronary stenting: flow cyto-metric detection ofwound-induced platelet activation.
        Coron Artery Dis. 1996; 7: 657-665
        • Brown DM
        • Kaiser PK
        • Michels M
        • et al.
        Ranibizumab versus verteporfin for neovascular age-related macular degeneration.
        N Engl J Med. 2006; 355: 1432-1434
        • Rosenfeld P
        • Brown D
        • Heier JS
        • et al.
        Ranibizumab for neo-vascular age-related macular degeneration.
        N Engl J Med. 2006; 355: 1419-1431
        • Treatment of Age-related Macular Degeneration With Photo-dynamic Therapy (TAP) Study Group
        Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials-TAP report.
        Arch Ophthalmol. 1999; 117: 1329-1345
        • Sharma S
        • Brown GC
        • Brown MM
        • et al.
        Converting visual acuity to utilities.
        Can JOphthalmol. 2000; 35: 267-272
        • Canadian Agency for Drugs and Technologies in Health
        Guidelines for the Economic Evaluation of Health Technologies: Canada. 3rd ed. The Agency, Ottawa, Ont.2006 (Available at) (Accessed March 12, 2007)
        • Fenwick E
        • Claxton K
        • Sculpher M
        Representing uncertainty: the role of cost-effectiveness acceptability curves.
        Health Econ. 2001; 10: 779-787
        • Costa RA
        • Jorge R
        • Calucci D
        • Cardillo JA
        • Melo Jr, LA
        • Scott IU
        Intravitreal bevacizumab for choroidal neovascular-ization caused by AMD (IBeNA Study): results of a phase-1 dose-escalation study.
        Invest Ophthalmol Vis Sci. 2006; 47: 4569-4578
        • Michels S
        • Rosenfeld P
        • Puliafito CA
        • Marcus EN
        • Venkatra-man AS
        Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study.
        Ophthalmology. 2005; 112: 1035-1047
        • Moshfeghi A
        • Rosenfeld P
        • Puliafito C
        • et al.
        Systemic bevaci-zumab (Avastin) therapy for neovascular age-related macular degeneration: twenty-four-week results of an uncontrolled open-label clinical study.
        Ophthalmology. 2006; 113: 2002.e1-2002.e12
        • Brown DM
        • Regillo CD
        Anti-VEGF agents in the treatment of neovascular age-related macular degeneration: applying clinical trial results to the treatment of everyday patients.
        Am JOphthalmol. 2007; 144: 627-637