IDEAS home Printed from https://ideas.repec.org/a/spr/pharme/v25y2007i10p863-879.html
   My bibliography  Save this article

Cost Effectiveness of Pegaptanib for the Treatment of Age-Related Macular Degeneration in the UK

Author

Listed:
  • Sorrel Wolowacz
  • Neil Roskell
  • Steven Kelly
  • Fiona Maciver
  • Chris Brand

Abstract

Background: Age-related macular degeneration (AMD) is the primary cause of vision loss in the elderly and results in significant economic and humanistic burden. The selective vascular endothelial growth factor inhibitor, pegaptanib (Macugen®) is indicated for patients with neovascular AMD. Guidance is needed regarding the cost effectiveness of treatment, any variation between sub-populations of differing clinical characteristics and the optimum duration of treatment. Objective: To estimate the cost effectiveness of pegaptanib versus best supportive care (BSC) for AMD from the perspective of the UK government, and to evaluate the impact of patient characteristics and differing treatment discontinuation scenarios. Methods: A cohort of 1000 patients aged >45 years with a best-corrected visual acuity (VA) in their better-seeing eye of ≤6/12 was modelled. Patients were either treated with pegaptanib (0.3mg every 6 weeks for a maximum of 2 years in their better-seeing eye only) or received BSC (no active treatment). Supportive services were provided for patients with a VA ≤6/60. A 10-year Markov model composed of 12 VA states (defined by individual Snellen lines) and a dead state was constructed. 1 Time-dependent transition probabilities for the loss and gain of Snellen lines were derived from parametric survival curves fitted to patient-level data from the VISION trials. Survival curves were fitted with treatment and baseline Snellen scores as covariates; additional curves were fitted with the addition of age, gender, lesion type or lesion size as covariates. Mortality rates were adjusted for the age, gender and VA of the population. Cost effectiveness was expressed as the incremental cost (IC) per vision-year saved and IC/QALY. Uncertainty was explored by probabilistic and univariate sensitivity analysis. Costs (year 2005 values) and outcomes were discounted at 3.5% per anum. Results: In the base-case analysis, treatment was targeted to patients with a VA of 6/12 to 6/95 and discontinued after 2 years, or earlier if VA fell below 6/95 or by ≥6 lines. The IC/QALY was estimated as £8023 (upper 95% CI £20 641). Cost effectiveness varied by age (age >75 years=£2033/QALY; age >75 years=£11 657/QALY) and by pre-treatment VA (6/12–6/95=£8023/QALY; 6/12–6/60=£6664/QALY; 6/12s-6/24=£1920/QALY). Gender and lesion type or size had little effect. Cost effectiveness was not sensitive to precise rules for treatment discontinuation, but was maximised if treatment was discontinued in patients no longer likely to benefit. Conclusions: The results suggest that pegaptanib treatment is likely to be cost effective across all groups studied, and marginally more cost effective in younger patients and those with better pre-treatment VA. Cost effectiveness appears to be optimised if treatment is discontinued after 1 year if individual patients’ VA has dropped by ≥6 lines from pre-treatment levels, or at any time if it drops below 6/95. However, strict application of discontinuation rules does not appear to be necessary for pegaptanib to be cost effective. Clinical judgement and patient preference should be an important determinant in decisions about stopping treatment. Copyright Adis Data Information BV 2007

Suggested Citation

  • Sorrel Wolowacz & Neil Roskell & Steven Kelly & Fiona Maciver & Chris Brand, 2007. "Cost Effectiveness of Pegaptanib for the Treatment of Age-Related Macular Degeneration in the UK," PharmacoEconomics, Springer, vol. 25(10), pages 863-879, October.
  • Handle: RePEc:spr:pharme:v:25:y:2007:i:10:p:863-879
    DOI: 10.2165/00019053-200725100-00005
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.2165/00019053-200725100-00005
    Download Restriction: Access to full text is restricted to subscribers.

    File URL: https://libkey.io/10.2165/00019053-200725100-00005?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Paul Mitchell & Lieven Annemans & Richard White & Meghan Gallagher & Simu Thomas, 2011. "Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration," PharmacoEconomics, Springer, vol. 29(2), pages 107-131, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharme:v:25:y:2007:i:10:p:863-879. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.