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Regenerative Therapy by Suprachoroidal Cell Autograft in Dry Age-related Macular Degeneration: Preliminary In Vivo Report
Published on: February 12, 2018
Cost-Effectiveness of Photobiomodulation for Intermediate Dry Age-Related Macular Degeneration: A Model-Based
Arjun Watane1, Andre Witkin1, Jeffrey Heier2
1From the Ophthalmic Consultants of Boston (A.W., A.W., J.H., C.S.), Boston, Massachusetts, USA; New England Eye Center (A.W., A.W.), Tufts University School of Medicine, Boston, Massachusetts, USA.
Purpose:
To evaluate the cost-effectiveness of photobiomodulation (PBM) for intermediate dry age-related macular degeneration (AMD) from the US healthcare payer perspective, using 24-month LIGHTSITE III trial data.
Design:
Model-based cost-effectiveness analysis using a 5-state Markov model with 6-month cycles over a 10-year horizon, discounting costs and outcomes at 3% annually.
Participants:
Modeled cohort of adults with bilateral intermediate dry AMD and best-corrected visual acuity (BCVA) 20/32-20/100, consistent with LIGHTSITE III eligibility.
Methods:
Transition probabilities were derived from LIGHTSITE III 24-month outcomes and AREDS natural history data. Costs were derived from 2025 Medicare Physician Fee Schedule and published claims-based sources. One-way and probabilistic sensitivity analyses, a societal perspective, a 2-year limited treatment scenario, and a 5-year national budget impact analysis were conducted.
Main Outcome Measures:
Quality-adjusted life-years (QALYs) derived from published visual acuity-to-utility mapping and VFQ-25-to-EQ-5D conversion of LIGHTSITE III quality-of-life data; incremental cost-effectiveness ratio (ICER) as cost per QALY; 5-year national budget impact.
Results:
PBM yielded 5.244 discounted QALYs at an incremental cost of $29,556 over 10 years, producing a base-case ICER of $73,910 per QALY, below both the $100,000 and $150,000 US willingness-to-pay thresholds. The ICER ranged from $36,700 ($1,000/course) to $117,694 per QALY (30% geographic atrophy [GA] reduction) across clinically realistic scenarios. Only the $5,000/course scenario exceeded both thresholds. The 5-year cumulative national budget impact was $25.0 billion at 20% uptake.
Conclusions:
PBM is cost-effective at conventional US willingness-to-pay thresholds, driven primarily by a 71.7% relative reduction in incident GA at 24 months. These findings support coverage consideration of PBM for intermediate dry AMD, pending independent replication of the GA reduction and prospective EQ-5D data collection.
