title: Cost-effectiveness of ocriplasmin for the treatment of vitreomacular traction and macular hole.
abstract: BACKGROUND
  If left untreated, vitreomacular traction (VMT) will infrequently improve through spontaneous resolution of vitreomacular adhesion (VMA), and patients remain at risk of further deterioration in vision. The mainstay of treatment for VMT is vitrectomy, an invasive procedure that carries the risk of rare but serious complications and further vision loss. As such, a 'watch and wait' approach is often adopted before this surgical intervention is performed. Ocriplasmin (microplasmin) is a potential alternative treatment for patients with symptomatic VMT that may remove the requirement for vitrectomy.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the cost-effectiveness of ocriplasmin for the treatment of VMT in comparison to standard of care.
  
  
  METHODS
  A cohort-based computer simulation model was developed, capturing three mutually exclusive subgroups: 1) VMT without epiretinal membrane (ERM) or full thickness macular hole (FTMH), 2) VMT with ERM but no FTMH, and 3) VMT with FTMH. Transition probabilities between health states, utilities, and resource utilisation were estimated based on clinical trial results, the literature, and expert opinion. The cost per quality-adjusted life year (QALY) gained was estimated over a lifetime, using UK unit costs and utilities associated with visual acuity, adverse events, metamorphopsia, and surgical interventions.
  
  
  METHODS
  Analyses were conducted from a UK payer perspective.
  
  
  METHODS
  Transition probabilities for the model were primarily estimated from patient-level data from the combined Phase 3 MIVI-TRUST trials in patients with symptomatic VMA/VMT, including when associated with a FTMH ≤400 µm.
  
  
  METHODS
  Ocriplasmin (microplasmin) is a one-time intravitreal injection designed specifically to release the abnormal traction between the macula and the vitreous and thereby treat VMT, as well as macular hole with persistent vitreous attachment.
  
  
  METHODS
  The main outcome measure of the economic evaluation was cost per QALY.
  
  
  RESULTS
  In all subgroups, ocriplasmin management generated more QALYs: 1) VMT without ERM or FTMH (0.105, (0.036, 0.191)); 2) VMT with ERM but no FTMH (0.041, (0.011, 0.131)); and 3) VMT with FTMH (0.053, (-0.002, 0.113)). The initial treatment costs were partially offset by later savings and net costs were estimated at £1,901 (£1,325, £2,474), £2,491 (£1,067, £2,511), and £1,912 (£1,233, £2,506), respectively. Costs per QALY were estimated at £18,056 (£8,241, £64,874), £61,059 (£8,269, £168,664), and £36,250 (-£144,788, £290,338), respectively. Short-term efficacy parameters were found to be key drivers of results.
  
  
  CONCLUSIONS
  Ocriplasmin is most cost-effective in VMT patients without either ERM or FTMH.
authors.affiliation: Pharmerit International, York, United Kingdom.
authors.forename: Craig
authors.initials: C
authors.lastname: Bennison
authors.affiliation: Pharmerit International, York, United Kingdom.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stephens
authors.affiliation: Xintera Ltd., St John's Innovation Centre, Cambridge, United Kingdom.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Lescrauwaet
authors.affiliation: Pharmerit International, York, United Kingdom; School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Van Hout
authors.affiliation: Department of Ophthalmology, School of Medicine, King's College London, London, United Kingdom.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Jackson
keywords: PPV; United Kingdom; anatomical outcomes; economic evaluation; quality adjusted life year; symptomatic vitreomacular adhesion; vitrectomy