title: Pharmacologic management of neovascular age-related macular degeneration: systematic review of economic evidence and primary economic evaluation.
abstract: OBJECTIVE
  To examine the economic implications for the Canadian health system of pharmacologic treatment of neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Systematic review of economic literature and a primary economic evaluation.
  
  
  METHODS
  Economic literature search identified 392 potentially relevant articles, 12 of which were included for final review.
  
  
  METHODS
  Studies were included if they met the following criteria: (i) provision of a summary measure of the trade-off between costs and consequences; (ii) participants of 40 years and older with neovascular AMD; (iii) interventions and comparators: comparison of photodynamic therapy using verteporfin (V-PDT), pegaptanib, bevacizumab, ranibizumab, anecortave acetate, intravitreal triamcinolone, placebo, or clinically relevant combinations; and (iv) outcome reported as an incremental measure of the implication of moving from the comparator to the intervention. The following databases were searched through the OVID interface: MEDLINE, EMBASE, BIOSIS Previews, CINAHL, PubMed, Health Economic Evaluations Database (HEED), and the Cochrane Library. For the economic evaluation, we took a decision analytic approach and modeled a cost-utility analysis, conducting it as a microsimulation of a Markov model.
  
  
  RESULTS
  In general, V-PDT is more cost effective than conventional macular laser, and pegaptanib is likely more cost effective than V-PDT. The primary economic analysis revealed ranibizumab to be effective but at an unacceptably high cost per quality-adjusted life year (QALY)(>$50,000 per QALY).
  
  
  CONCLUSIONS
  Although ranibizumab is effective for wet AMD, its cost is unacceptably high based on cost-utility theory.
authors.affiliation: Department of Ophthalmology, University of Western Ontario, London, Ont. William.Hodge@sjhc.london.on.ca
authors.forename: William
authors.initials: W
authors.lastname: Hodge
authors.forename: Allan
authors.initials: A
authors.lastname: Brown
authors.forename: Steve
authors.initials: S
authors.lastname: Kymes
authors.forename: Alan
authors.initials: A
authors.lastname: Cruess
authors.forename: Gord
authors.initials: G
authors.lastname: Blackhouse
authors.forename: Robert
authors.initials: R
authors.lastname: Hopkins
authors.forename: Lynda
authors.initials: L
authors.lastname: McGahan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.forename: Irene
authors.initials: I
authors.lastname: Pan
authors.forename: Jason
authors.initials: J
authors.lastname: Blair
authors.forename: David
authors.initials: D
authors.lastname: Vollman
authors.forename: Andra
authors.initials: A
authors.lastname: Morrison
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized; D002170:Canada; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D009313:National Health Programs; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000191:economics*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab