Pharmacologic management of neovascular age-related macular degeneration: systematic review of economic evidence and primary economic evaluation.
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.
Hodge
William
W
Department of Ophthalmology, University of Western Ontario, London, Ont. William.Hodge@sjhc.london.on.ca
Brown
Allan
A
Kymes
Steve
S
Cruess
Alan
A
Blackhouse
Gord
G
Hopkins
Robert
R
McGahan
Lynda
L
Sharma
Sanjay
S
Pan
Irene
I
Blair
Jason
J
Vollman
David
D
Morrison
Andra
A
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*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab