The cost-utility of photodynamic therapy in eyes with neovascular macular degeneration--a value-based reappraisal with 5-year data.
OBJECTIVE
To assess the value conferred by photodynamic therapy (PDT) and the cost-utility of PDT for the treatment of classic, subfoveal choroidal neovascularization associated with age-related macular degeneration (ARMD).


METHODS
Average cost-utility analysis utilizing clinical trial data, patient-based time tradeoff utility preferences, and a third party insurer cost perspective.


METHODS
Five-year visual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Investigation were modeled into a 12-year, value-based, reference case, cost-utility model utilizing year 2004 Medicare costs and an outcome of dollar/QALY (dollars/quality-adjusted life-year). Discounting of outcomes and costs using net present value analysis with a 3% annual rate was performed as recommended by the Panel for Cost-Effectiveness in Health and Medicine.


RESULTS
PDT with verteporfin (Visudyne) dye for classic subfoveal choroidal neovascularization confers an 8.1% quality of life (value) improvement over the 12-year life expectancy of the reference case, while during the last 8 years the value improvement is 9.5%. The average cost-utility of the intervention is dollar 31,103/QALY (quality-adjusted life-year). Extensive one-way sensitivity analysis values range from dollar 20,736/QALY if treatment efficacy is increased by 50% to dollar 62,207 if treatment efficacy is decreased by 50%, indicating robustness of the model.


CONCLUSIONS
PDT using verteporfin dye to treat classic subfoveal choroidal neovascularization is a very cost-effective treatment by conventional standards. The marked improvement in cost-effectiveness compared with a previous report results from the facts that the treatment benefit increasingly accrues during 5 years of follow-up while the number of yearly treatments diminishes markedly during that time.
Brown
Gary C
GC
Center for Value-Based Medicine, Flourtown, Pennsylvania 19031, USA. gbrown@valuebasedmedicine.com
Brown
Melissa M
MM
Campanella
Joseph
J
Beauchamp
George R
GR
D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000191:economics* / Q000209:etiology; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D017059:Models, Econometric; D010778:Photochemotherapy / Q000191:economics*; D017319:Photosensitizing Agents / Q000191:economics* / Q000627:therapeutic use; D011166:Porphyrins / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin