title: Cost analysis comparing adjuvant epimacular brachytherapy with anti-VEGF monotherapy for the management of neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To consider the cost implication of adopting epimacular brachytherapy (EMB) for the treatment of neovascular (wet) age-related macular degeneration (wAMD), compared with ranibizumab or bevacizumab monotherapy.
  
  
  METHODS
  This analysis compared the cumulative 3-year costs of anti-VEGF (vascular endothelial growth factor) monotherapy to EMB combined with anti-VEGF therapy. Two patient groups were considered: newly diagnosed (treatment-naïve) patients; and patients already receiving chronic anti-VEGF therapy.
  
  
  RESULTS
  In the treatment-naïve patients, the highest cumulative treatment costs were associated with ranibizumab monotherapy (£25,658), followed by bevacizumab monotherapy (£16,177), EMB with ranibizumab (£14,002), then EMB with bevacizumab (£10,289). In previously treated patients, the highest treatment costs were ranibizumab monotherapy (£18,355), followed by EMB with ranibizumab (£17,428), bevacizumab monotherapy (£16,177), then EMB with bevacizumab (£12,129).
  
  
  CONCLUSIONS
  EMB combined with anti-VEGF treatment has the potential to yield considerable cost savings, compared with anti-VEGF monotherapy. If the ongoing large studies of EMB confirm the published feasibility data, then adjuvant EMB may represent a cost-effective alternative to anti-VEGF monotherapy.
authors.affiliation: School of Medicine, King's College, London, UK. t.jackson1@nhs.net
authors.forename: T L
authors.initials: TL
authors.lastname: Jackson
authors.forename: L
authors.initials: L
authors.lastname: Kirkpatrick
authors.forename: G
authors.initials: G
authors.lastname: Tang
authors.forename: S
authors.initials: S
authors.lastname: Prasad
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab; D001918:Brachytherapy / Q000191:economics* / Q000379:methods; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D008268:Macular Degeneration / Q000191:economics / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D000069579:Ranibizumab; D013222:State Medicine / Q000191:economics; D042442:Vascular Endothelial Growth Factors / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042442:Vascular Endothelial Growth Factors; D000068258:Bevacizumab; D000069579:Ranibizumab