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Cost-Effectiveness Model for Age-Related Macular Degeneration: Comparing Macugen® to Visudyne®


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 Macugen=65533 to Visudyne=65533. Presented at ISPOR 8th Annual European Congress, Florence, Italy.


ABSTRACT:OBJECTIVE: To develop a health-economic assessment forMacugen (pegaptanib sodium), a new treatment for age-relatedmacular degeneration (AMD). A comprehensive modelcompares Macugen, indicated for all patients with neovascularAMD, relative to the existing photodynamic therapy (PDT) withVisudyne (verteporfin).METHODS: A Markov framework was used to model thelifetime movement of an AMD cohort through five healthstates based on visual acuity (VA): >20/40, 20/40 to >20/80,20/80 to >20/200, 20/200 to >20/400, and ≤20/400. The modelincorporates patients across all lesion subtypes: predominatelyclassic, minimally classic, and occult. All drug and procedurecosts were derived from US published sources, includingMedicare Part B Drugs Average Sales Price and RBRVS. Expertinterviews were conducted to determine adverse event (AE)treatment patterns and vision rehabilitation resource use.Relative risks and costs associated with effects associated withdeclining VA (depression, bone fractures, skilled nursing facilitycare, and nursing home care) were extracted from a Medicareanalysis. Transition probabilities were derived from publishedtrial data for both products for each of the 3-month cycles.Utilities were derived from similar published sources as previous AMD models. Results are expressed as vision years, qualityadjustedlife years (QALYs), drug, treatment, AE, and other costs, aswell as the average cost per vision year and QALY.RESULTS: For a lifetime analysis the average cost per vision yearwas $20,662 for Macugen and $26,073 for Visudyne and the averagecost per QALY was $19,803 for Macugen and $20,131 for Visudyne. Apatient treated with Macugen had on average 3.68 vision years over alifetime compared to 2.65 for a patient treated with Visudyne.CONCLUSIONS: Macugen treatment produces more years of sightthan Visudyne for AMD treated patients. Macugen is more costeffectiveversus active treatment with Visudyne. A limitation of themodel is the absence of direct clinical comparison between theproducts.INTRODUCTION:• Population-based studies across developed countries have estimatedthe prevalence rate of late AMD to be between 1.7 and 1.9 per 100individuals3.• By the year 2020, as many as 8 million individuals aged 65 years andolder will suffer from AMD5.• The economic burden of AMD is high because people with impairedvision due to AMD may experience reduced independence and a greater risk than the general population of falls and fractures,depression, and the need for daily support services or nursinghome care.• Macugen is the first aptamer and selective VEGF inhibitordeveloped for the treatment of ocular neovascularization. It isthe first approved therapy that targets the underlyingpathological process common to all subtypes and classificationsof neovascular AMD.• Prior to the introduction of Macugen, PDT with Visudyne wasthe standard of care. PDT is a laser-based procedure thatcombines an intravenously administered sensitizing agent witha lower energy laser. Visudyne is indicated for patients withpredominantly classic lesions and, in some instances, smalloccult lesions.• Understanding the cost-effectiveness of Macugen compared toVisudyne could help payers in various countries make informeddecisions about licensing and reimbursement.OBJECTIVE:To build a comprehensive, accurate, and customizable economicmodel to assess the cost-effectiveness of Macugen versusVisudyne.