CME review: A cost-utility analysis of laser photocoagulation for extrafoveal choroidal neovascularization.
OBJECTIVE
The purpose of this study was to perform a reference case (average case), cost-utility analysis of laser photocoagulation for extrafoveal choroidal neovascularization associated with age-related macular degeneration using a model incorporating patient preferences.


METHODS
Visual acuity data for patients treated and observed over a 5-year period were obtained from previously reported studies by the Macular Photocoagulation Study Group. The results from this prospective, randomized trial were incorporated in a cost-utility model using time-trade-off utility analysis and decision analysis with Markov modeling according to the recommendations of the Panel on Cost-Effectiveness in Health and Medicine. Expenditures and health care benefits were each discounted at a 3% yearly rate.


RESULTS
Laser photocoagulation therapy for extrafoveal choroidal neovascularization in age-related macular degeneration, compared with observation, resulted in a mean gain of 0.0740 quality-adjusted life-year per patient treated. The mean cost of treatment for the average patient totaled 1,715 US dollars. The cost divided by the health care benefit resulted in 23,176 year 2001 US dollars per quality-adjusted life-year gained for this procedure for a reference case. Sensitivity analyses, varying the cost, utility values, and discount parameters, resulted in dollars per quality-adjusted life-year gained ranging from 16,117 to 49,766 US dollars.


CONCLUSIONS
Laser photocoagulation for extrafoveal choroidal neovascularization associated with age-related macular degeneration appears to be cost-effective when compared with interventions across multiple medical specialties.
Busbee
Brandon G
BG
Center for Value-Based Medicine, and Department of Ophthalmology, Tufts New England Medical Center, USA.
Brown
Melissa M
MM
Brown
Gary C
GC
Sharma
Sanjay
S
D020256:Choroidal Neovascularization / Q000191:economics* / Q000209:etiology / Q000601:surgery; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005584:Fovea Centralis; D017048:Health Care Costs; D006801:Humans; D017075:Laser Coagulation / Q000191:economics*; D008268:Macular Degeneration / Q000150:complications / Q000191:economics / Q000601:surgery; D008390:Markov Chains; D015337:Multicenter Studies as Topic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D014792:Visual Acuity