title: Cost-effectiveness of treating wet age-related macular degeneration at the Kuopio University Hospital in Finland based on a two-eye Markov transition model.
abstract: OBJECTIVE
  Wet age-related macular degeneration (AMD) is the leading cause of blindness worldwide, which can be treated with regular intraocular anti-vascular endothelial growth factor (VEGF) injections. In this study, we wanted to evaluate whether less frequent injections of aflibercept would make it more cost-effective when compared with ranibizumab and low priced bevacizumab.
  
  
  METHODS
  We used a two-eye model to simulate the progression and the treatment of the disease. We selected an 8-year period, 3-month cycles and five health states based on the visual acuity of the better-seeing eye. The transition probabilities and utilities attached to the health states were gathered from previous studies. We conducted the analysis from the hospital perspective and we used the health care costs obtained from Kuopio University Hospital. The costs of intraocular adverse events were taken into account.
  
  
  RESULTS
  The incremental cost-effectiveness ratio (ICER) with 3% discount rate (€/QALY) for aflibercept compared with monthly bevacizumab was 1 801 228 and when compared with ranibizumab given as needed, the ICER was minus 3 716 943. The sensitivity analysis showed that a change of 20% of the estimated model parameters or a longer follow-up period did not influence these conclusions.
  
  
  CONCLUSIONS
  A two-eye Markov transition model was developed to analyse the cost-effectiveness of wet AMD treatment, as quality of life years (QALYs) are largely based on the visual acuity of the better-seeing eye. Monthly injected bevacizumab was the most cost-effective treatment and monthly ranibizumab the least effective.
authors.affiliation: Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland. pasi.vottonen@kuh.fi.
authors.forename: Pasi
authors.initials: P
authors.lastname: Vottonen
authors.affiliation: Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
authors.forename: Eila
authors.initials: E
authors.lastname: Kankaanpää
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D005387:Finland; D005102:Health Expenditures; D006785:Hospitals, University; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D000069579:Ranibizumab / Q000008:administration & dosage / Q000191:economics; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000191:economics; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000191:economics*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: aflibercept; bevacizumab; cost-effectiveness; exudative age-related macular degeneration; ranibizumab