title: Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis.
abstract: OBJECTIVE
  To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.
  
  
  METHODS
  Randomized, controlled, clinical trial.
  
  
  METHODS
  Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.
  
  
  METHODS
  Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.
  
  
  METHODS
  The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.
  
  
  RESULTS
  The ICER at 3 years was $297,800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16,900; P < 0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50,000/QALY and $100,000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41,200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50,000/QALY and $100,000/QALY was 0.53 and 0.74, respectively.
  
  
  CONCLUSIONS
  Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.
authors.affiliation: Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Center for Clinical Trials, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Division of Biostatistics and Bioinformatics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: esugar2@jhu.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sugar
authors.affiliation: Department Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Center for Clinical Trials, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Janet T
authors.initials: JT
authors.lastname: Holbrook
authors.affiliation: Ocular Inflammation Service, Department of Ophthalmology/Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology/Scheie Eye Institute, The University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
authors.affiliation: Department Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Center for Clinical Trials, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Alyce E
authors.initials: AE
authors.lastname: Burke
authors.affiliation: Department Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Center for Clinical Trials, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lea T
authors.initials: LT
authors.lastname: Drye
authors.affiliation: Department Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Louis
authors.affiliation: Department Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: douglas.jabs@mssm.edu.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Altaweel
authors.affiliation: The Johns Hopkins University Carey Business School, Baltimore, Maryland.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D004343:Drug Implants; D005446:Fluocinolone Acetonide / Q000008:administration & dosage* / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015864:Panuveitis / Q000188:drug therapy*; D019057:Quality-Adjusted Life Years; D014481:United States; D015867:Uveitis, Intermediate / Q000188:drug therapy*; D015866:Uveitis, Posterior / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D004343:Drug Implants; D005446:Fluocinolone Acetonide