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Published on: July 6, 2015
Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization
G C Brown1, M M Brown, S Sharma
1Retina Vascular Unit, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Objective:
To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization.
Design:
Computer-based econometric modeling.
Methods:
The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money.
Database:
Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis.
Intervention:
Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration.
Main Outcome Measure:
Cost per quality-adjusted life-year ($/QALY gained) associated with laser therapy.
Results:
Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant $/QALY gained was $5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a $/QALY gained of $4974 with no gained discount rate and $11,633 with a yearly discount rate of 10%.
Conclusions:
The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.
