OBJECTIVE: To compare the cost-effectiveness of early treatment in disease progression of age-related macular degeneration (AMD) to later treatment. A comprehensive model compares starting treatment with Macugen (pegaptanib sodium), a new treatment for AMD indicated for all patients with neovascular AMD and standard care in patients with early disease progression (i.e., better visual acuity [VA]) versus late disease progression (i.e., worse VA).
METHODS: A Markov framework was used to model lifetime movement of an AMD cohort through health states based on VA: >20/40, 20/40 to >20/80, 20/80 to >20/200, 20/200 to >20/400, and 20/400. Drug and procedure costs were derived from US published sources. Expert interviews were conducted to determine adverse events treatment patterns and vision rehabilitation resource use. Relative risks and costs associated with effects associated with declining VA were extracted from a Medicare analysis. Transition probabilities were derived from published trial data for both products for each of the 3-month cycles. Utilities were derived from similar published sources as previous AMD models. Results are expressed as vision years, quality-adjusted life years (QALYs), medical costs, and other costs, as well as the incremental cost per vision year and QALY gained. Three runs of the model were conducted with cohorts of patients starting in one of the following health states: 20/40 to >20/80; 20/80 to >20/200; and 20/200 to >20/400.
RESULTS: For lifetime analysis incremental cost-effectiveness ratios (ICERs) per vision year gained were $19,744, $23,377, and $58,512 and ICERs per QALY gained were $46,911, $67,058, and $135,400 versus standard care for patients started in the 20/40 to >20/80, 20/80 to >20/200, and 20/200 to >20/400 states, respectively.
CONCLUSIONS: Treating patients early when presenting with AMD results in lower ICERs than waiting to treat patients until their VA worsens. To achieve maximum cost benefits treatment should begin as soon as possible.
