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Cost-Effectiveness Model for Age-Related Macular Degeneration: Comparing Early and Late Macugen® Treatment


Earnshaw, S. R., Javitt, J. C., Zlateva, G. P., Pleil, A. M., Graham, C. N., Brogan, A. J., ... Adamis, A. P. (2005, November). Cost-Effectiveness Model for Age-Related Macular Degeneration: Comparing Early and Late Macugen=65533 Treatment. Presented at ISPOR 8th Annual European Congress, Florence, Italy.


ABSTRACT:OBJECTIVE: To compare the cost-effectiveness of treatment early indisease progression compared to later treatment for patients withage-related macular degeneration (AMD). A comprehensive modelcompares starting treatment with Macugen (pegaptanib sodium), anew treatment for AMD indicated for all patients with neovascularAMD, and standard care in an early stage of the disease (i.e., bettervisual acuity [VA]) versus a later stage of the disease (i.e., worse VA).METHODS: A Markov framework was used to model lifetimemovement of an AMD cohort through health states based on VA:>20/40, 20/40 to >20/80, 20/80 to >20/200, 20/200 to >20/400, and≤20/400. Drug and procedure costs were derived from US publishedsources. Expert interviews were conducted to determine adverseevent (AE) treatment patterns and vision rehabilitation resource use.Relative risks and costs associated with effects associated withdeclining VA were extracted from a Medicare analysis. Transitionprobabilities were derived from published trial data for each of the3-month cycles. Utilities were derived from similar publishedsources as previous AMD models. Results are expressed as visionyears, quality-adjusted life years (QALYs), drug, treatment, AE, andother costs, as well as the incremental cost per vision year and QALY gained. Three runs of the model were conducted with cohortsof patients starting in the health states 20/40 to >20/80, 20/80 to>20/200, and 20/200 to >20/400.RESULTS: For lifetime analysis incremental cost-effectiveness ratios(ICERs) per vision year gained were $20,825, $24,572, and $61,350and ICERs per QALY gained were $49,480, $70,485, and $141,969versus standard care for patients starting in the 20/40 to >20/80,20/80 to >20/200, and 20/200 to >20/400 states, respectively.CONCLUSIONS: Treating patients early when presenting with AMDresults in lower ICERs than waiting to treat patients until their VAworsens. To achieve maximum cost benefits, treatment shouldbegin as soon as possible.INTRODUCTION:• Population-based studies across developed countries haveestimated the prevalence rate of late AMD to be between 1.7 and1.9 per 100 individuals5.• By the year 2020, as many as 8 million individuals aged 65 yearsand older will suffer from AMD7.• The resulting visual impairment affects patient quality of life asmuch as arthritis, asthma, diabetes, and stroke3. In Europe, per-patient direct medical costs associated with AMDmanagement have been estimated between €10,668 and €13,073per year1.• The economic burden of AMD is high because people withimpaired vision due to AMD may experience reducedindependence and a greater risk than the general population offalls and fractures, depression, and the need for daily supportservices or nursing home care.• Macugen is is the first pharmacological treatment for subfovealneovascular AMD that helps slow the progression of the diseaseand improves visual acuity for some patients.• Preventing rapid vision loss could help reduce resource useassociated with impaired vision.OBJECTIVE:To build a comprehensive economic model to assess the costeffectivenessof treating neovascular AMD patients with Macugencompared to standard care while their visual acuity is still relativelygood (early treatment) versus waiting until their visual acuityworsens (middle or late treatment).