title: Treatment Options for Age-Related Macular Degeneration: A Budget Impact Analysis from the Perspective of the Brazilian Public Health System.
abstract: BACKGROUND
  Age-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system.
  
  
  OBJECTIVE
  To conduct a budget impact analysis of three scenarios for the introduction of AMD treatments: all the medications (verteporfin, ranibizumab, and bevacizumab-the reference scenario), ranibizumab alone, and bevacizumab alone.
  
  
  METHODS
  The basic assumption was that the Brazilian public health system would treat the entire target population with AMD aged > 70 years between 2008 and 2011. The size of the population of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procurement policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the reference scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analyses were run to check the robustness of the model.
  
  
  RESULTS
  In four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 for bevacizumab, US$11,469.39 for ranibizumab, and US$4,376.28 for verteporfin. The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period. The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.
  
  
  CONCLUSIONS
  The introduction of bevacizumab for the treatment of AMD is recommended for the Brazilian Public Health System.
authors.affiliation: Oswaldo Cruz Foundation, Brasília, Distrito Federal, Brazil.
authors.forename: Flávia Tavares Silva
authors.initials: FT
authors.lastname: Elias
authors.affiliation: University of Brasilia, Brasília, Distrito Federal, Brazil.
authors.forename: Everton Nunes da
authors.initials: EN
authors.lastname: Silva
authors.affiliation: Federal University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Rubens
authors.initials: R
authors.lastname: Belfort
authors.affiliation: Federal University of Amazonas, Manaus, Amazonas, Brazil.
authors.forename: Marcus Tolentino
authors.initials: MT
authors.lastname: Silva
authors.affiliation: Federal University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Álvaro Nagib
authors.initials: ÁN
authors.lastname: Atallah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D008297:Male; D018803:Models, Economic