title: Cost-effectiveness of intravitreal aflibercept versus other treatments for wet age-related macular degeneration in Japan.
abstract: OBJECTIVE
  This analysis estimated the cost-effectiveness of intravitreal aflibercept injection(s) (IAI) for wet age-related macular degeneration (wAMD) compared with other treatments in Japan.
  
  
  METHODS
  This was a cost-utility analysis based on published data. A state-transition cohort model was constructed with six health states based on best-corrected visual acuity in the better-seeing eye. The cycle time was 4 weeks, and the time horizon was 12 years. The model compared IAI 2 mg every 8 weeks (2q8) for 2 years after three initial monthly injections, ranibizumab as needed, ranibizumab 0.5 mg every 4 weeks (0.5q4), pegaptanib sodium 0.3 mg every 6 weeks, verteporfin photodynamic therapy (PDT), and best supportive care, assumed to include medical management and monitoring, but no active therapy. Costs (expressed as Japanese yen [JPY]) and quality-adjusted life years (QALYs) gained were estimated for each treatment and discounted at 2.0%. Input data were obtained from clinical studies, the Japanese drug tariff and social insurance reimbursement schedule, and expert opinion. The analysis was conducted from the societal perspective, including medical costs as well as costs of blindness.
  
  
  RESULTS
  IAI 2q8 was dominant (i.e. more effective in terms of QALYs and less costly) to all other comparators (ranibizumab as needed, ranibizumab 0.5q4, pegaptanib sodium, PDT, and best supportive care), as shown by the incremental cost-utility ratio (i.e. cost per QALY gained).
  
  
  CONCLUSIONS
  The strengths of the analysis include the wide range of comparators evaluated and the use of Japanese-specific utility data. The limitations include the use of one eye, inclusion of published data up to 2 years only, and assumptions on disease course over 5 years.
  
  
  CONCLUSIONS
  IAI 2q8 was more effective in terms of QALYs and less costly compared with other treatments for wAMD in Japan.
authors.affiliation: a Singapore National Eye Centre , Singapore.|b Singapore Eye Research Institute , Singapore.|c Duke-NUS (National Universityof Singapore) Graduate Medical School , Singapore.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yanagi
authors.affiliation: d Bayer Yakuhin, Ltd. , Osaka , Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Fukuda
authors.affiliation: e IMS Health , London , UK.
authors.forename: Victor
authors.initials: V
authors.lastname: Barzey
authors.affiliation: d Bayer Yakuhin, Ltd. , Osaka , Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Adachi
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006801:Humans; D058449:Intravitreal Injections; D007564:Japan; D008297:Male; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000191:economics*; D014226:Triazenes / Q000008:administration & dosage / Q000191:economics; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D017319:Photosensitizing Agents; D011993:Recombinant Fusion Proteins; D014226:Triazenes; C533178:aflibercept; C008848:1-phenyl-3,3-dimethyltriazene; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Intravitreal aflibercept injection; cost utility analysis; cost-effectiveness analysis; quality-adjusted life years; wet age-related macular degeneration