Value-based medicine and interventions for macular degeneration.
OBJECTIVE
The aim of this article is to review the patient value conferred by interventions for neovascular macular degeneration.


RESULTS
Value-based medicine is the practice of medicine based upon the patient value (improvement in quality of life and length of life) conferred by an intervention. For ophthalmologic interventions, in which length-of-life is generally unaffected, the value gain is equivalent to the improvement in quality of life. Photodynamic therapy delivers a value gain (improvement in quality of life) of 8.1% for the average person with classic subfoveal choroidal neovascularization, while laser photocoagulation for the same entity confers a 4.4% improvement in quality of life. Preliminary data suggest the value gain for the treatment of occult/minimally classic choroidal neovascularization with ranibizumab is greater than 15%. The average value gain for statins for the treatment of hyperlipidemia is 3.9%, while that for the use of biphosphonates for the treatment of osteoporosis is 1.1% and that for drugs to treat benign prostatic hyperplasia is 1-2%.


CONCLUSIONS
Interventions, especially ranibizumab therapy, for neovascular macular degeneration appear to deliver an extraordinary degree of value compared with many other interventions across healthcare.
Brown
Melissa M
MM
Center for Value-Based Medicine, Flourtown, USA. mbrown@valuebasedmedicine.com
Brown
Gary C
GC
Brown
Heidi
H
D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D008268:Macular Degeneration / Q000628:therapy*; D011788:Quality of Life