Verteporfin photodynamic therapy cohort study: report 3: cost effectiveness and lessons for future evaluations.
OBJECTIVE
To report (1) the costs of verteporfin photodynamic therapy (VPDT) in routine treatment of neovascular age-related macular degeneration (nAMD), (2) the relationship between health and social service costs and best-corrected visual acuity (BCVA), (3) the cost-effectiveness of VPDT versus a best supportive care (BSC) group who were assumed to have no active treatment, and (4) lessons for future cost-effectiveness analyses (CEAs).


METHODS
The CEA of VPDT versus BSC that uses health-related quality of life (HrQoL), resource use, and visual acuity data from the United Kingdom (UK) VPDT Cohort Study.


METHODS
Data on VPDT use were collected from patients attending 45 ophthalmology provider units in the UK National Health Service, 15 units collected data on self-reported use of services.


METHODS
Incremental costs of VPDT versus BSC were calculated from treatment costs, change in cost associated with declining BCVA, and difference in BCVA previously attributed to VPDT. Similarly, incremental quality-adjusted life years (QALYs) were calculated from change in HRQoL associated with declining BCVA, giving an incremental cost per QALY of VPDT versus BSC over 2 years.


METHODS
Incremental costs (UK pounds [ pound]; United States dollars [$]); incremental QALYs; costs per QALY.


RESULTS
The treatment costs of VDPT were pound 3026 ($4544) in year 1 and pound 845 ($1269) in year 2. For patients who used services, a 5-letter decrease in BCVA was associated with an increase in annual costs of approximately pound 110 ($165; 95% confidence intervals, approximately pound 48 [$72] to pound 174 [$261]). The incremental costs and QALYs for VPDT were pound 3514 ($5276) and 0.021, respectively, giving incremental costs per QALY gained of pound 170000 ($255000).


CONCLUSIONS
Verteporfin photodynamic therapy is unlikely to be cost effective for patients with nAMD. This article provides realistic estimates of VPDT costs and the costs associated with declining vision. Future studies can follow this approach to assess accurately the cost effectiveness of new interventions for nAMD.
Grieve
Richard
R
The London School of Hygiene and Tropical Medicine, London, England. richard.grieve@lshtm.ac.uk
Guerriero
Carla
C
Walker
Jemma
J
Tomlin
Keith
K
Langham
Julia
J
Harding
Simon
S
Chakravathy
Usha
U
Carpenter
James
J
Reeves
Barnaby C
BC
D000368:Aged; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy / Q000191:economics*; D008297:Male; D010778:Photochemotherapy / Q000191:economics*; D017319:Photosensitizing Agents / Q000191:economics* / Q000627:therapeutic use; D011166:Porphyrins / Q000191:economics* / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012947:Social Work / Q000191:economics; D013222:State Medicine; D006113:United Kingdom; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin