Date and Time
April 30, 2008
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Swati Tole - Stanford University

Background: Age-related macular degeneration (AMD) is the most common cause of vision loss among individuals over the age of 50 in industrialized nations, affecting more than 25 million people worldwide. As our population ages, the prevalence of AMD is expected to double by 2020. In the United States, vision loss is associated with poor quality of life, increased morbidity (e.g. hip fractures, depression), excess mortality, more frequent use of medical services, and societal costs estimated at more than $50 billion per year. Recent medical advances have led to development of treatments for AMD; however, these therapies are expensive, projected to cost $1.6 billion during 2008 alone. To clarify the value of these medications, we sought to evaluate the cost effectiveness of treatments for AMD.

Methods: We created a Markov model to quantify health-related costs and benefits associated with three FDA-approved treatments for AMD – verteporfin, pegaptanib, and ranibizumab - compared to no treatment. We classified patients based on nine different visual acuity states. We included costs of treatment, follow up, side effects, general health care, and excess health care associated with vision loss. We estimated disease progression and effectiveness of treatments based on published randomized controlled trials. We followed patients over their lifetimes, and discounted costs and outcomes at 3% per year.

Results: In our base case analysis, verteporfin cost $13,800 more than no treatment and improved life expectancy by 0.49 quality-adjusted life years (QALYs), yielding an incremental cost effectiveness ratio (ICER) of $27,800 per QALY gained compared to no treatment. Pegaptanib was modestly more expensive but only minimally more effective than verteporfin, and was therefore not cost effective in our base case. Ranibizumab was the most expensive and most effective treatment, and cost $37,500 per QALY gained compared to verteporfin. Our results were sensitive to the effectiveness of pegaptanib, subtype of AMD lesion, and whether treatment was administered in the first or second affected eye.

Conclusion: Verteporfin and ranibizumab are effective and cost effective treatments for age-related macular degeneration. Better assessments of excess medical costs associated with AMD and longer duration of medication follow up data may help elucidate the value of treatments.