The cost-utility of photodynamic therapy in eyes with neovascular macular degeneration - A value-based reappraisal with 5-year data

PURPOSE: To assess the value conferred by photodynamic therapy (PDT) and the cost,utility of PDT for the treatment of classic, subfoveal choroidal neovascularization associated with age-related macular degeneration (ARMD). DESIGN: Average cost-utility analysis utilizing clinical trial data, patient-based time tradeoff utility preferences, and a third party insurer cost perspective. METHODS: Five-year visual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Investigation were modeled into a 12-year, value,based, reference case, Costa utility model utilizing year 2004 Medicare costs and an outcome of $/QALY (dollars/quality-adjusted life, year). Discounting of outcomes and costs using net present value analysis with a 3% annual rate was performed as recommended by the Panel for Cost, Effectiveness in Health and Medicine. RESULTS: PDT with verteporfin (Visudyne) dye for classic subfoveal choroidal neovascularization confers an 8.1% quality of life (value) improvement over the 12-year life expectancy of the reference case, while during the last 8 years the value improvement is 9.5%. The average cost,utility of the intervention is $31,103/ QALY (quality-adjusted life year). Extensive one-way sensitivity analysis values range from $20,736/QALY if treatment efficacy is increased by 50% to $62,207 if treatment efficacy is decreased by 50%, indicating robustness of the model. CONCLUSIONS: PDT using verteporfin dye to treat classic subfoveal choroidal neovascularization is a very cost-effective treatment by conventional standards. The marked improvement in cost effectiveness compared with a previous report results from the facts that the treatment benefit increasingly accrues during 5 years of follow-up while the number of yearly treatments diminishes markedly during that time. (Am J Ophthalmol 2005;140:679-687. (c) 2005 by Elsevier Inc. All rights reserved).