Economic Implications of Current Age-Related Macular Degeneration Treatments

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: To measure the cost versus benefit of age-related macular degeneration (AMD) treatment strategies, existing and proposed, in the postranibizumab era. Design: Cost-effectiveness model. Participants: None. Methods: University with hospital-based practice modeling of clinical examination, imaging, and treatment schedules were constructed considering published protocols where available, or by estimating usual practices. Medicare-allowable reimbursement schedules for a hospital-based, south Florida practice in 2007 were used to calculate costs of treatment. The lines of vision saved were deduced from published reports or using identified assumptions. This information was used to calculate cost per lines saved and, using actuarial tables data, costs per line-year saved were calculated. Main Outcome Measure: Cost ($US) per line-year. Results: Consensus control values of expected lines loss if untreated (natural history) were established from published reports (2.5 lines at 1 year; 3.5 at 2 years) and photodynamic therapy (2.0 lines at 1 year; 3.0 at 2 years) for use in calculating lines of vision saved in studies without untreated control groups. The cost per line-year for 1 year of treatment ranged from a low of $84 with as-needed bevacizumab to $766 for protocol-style use of ranibizumab. Combination treatment regimens yielded a range of $71 to $269. The pharmaceutical proportion of treatment costs is higher than professional or facility costs, ranging to 83% for protocol-style ranibizumab. Conclusions: Pharmaceutical-based treatments of AMD have markedly improved visual outcomes, but also have escalated costs markedly. Treatment regimens involving as-needed dosing, alternate medications, and combination therapy may preserve benefit for substantially lower costs. Disparate safety profiles would require consideration in choosing treatment regimens. Cost-benefit issues must be considered in AMD treatment regimens. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish
Pages (from-to)481-487
Number of pages7
JournalOphthalmology
Volume116
Issue number3
DOIs
StatePublished - Mar 1 2009

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Macular Degeneration
Economics
Costs and Cost Analysis
Cost-Benefit Analysis
Therapeutics
Disclosure
Health Care Costs
Appointments and Schedules
Photochemotherapy
Medicare
Natural History
Pharmaceutical Preparations
Consensus
Outcome Assessment (Health Care)
Safety
Control Groups

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Economic Implications of Current Age-Related Macular Degeneration Treatments. / Smiddy, William E.

In: Ophthalmology, Vol. 116, No. 3, 01.03.2009, p. 481-487.

Research output: Contribution to journalArticle

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