Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization

Objective: To perform a patient preference-based, incremental cost-effectiv eness analysis for laser treatment of subfoveal choroidal neovascularizatio n. Design: Computer-based econometric modeling. Methods: The cost effectiveness of laser photocoagulation therapy was compa red 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 econo mic principles of present value analysis with discounting to account for th e 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. Interventions Modeled laser therapy for s ubfoveal choroidal neovasacularization in patients with age-related macular degeneration. Main Outcome Measure: Cost per quality-adjusted life-year ($/QALY gained) a ssociated with laser therapy, Results: Laser photocoagulation therapy for subfoveal choroidal neovascular ization, as compared with no treatment, resulted in a mean gain of 0.257 QA LYs 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 $562 9. 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 y early 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 diffe rent medical specialties. (C) 2000 by the American Academy of Ophthalmology .