The cost-effectiveness of photodynamic therapy for fellow eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration

Purpose: Photodynamic therapy (PDT) has recently been demonstrated to be be neficial for the treatment of subfoveal choroidal neovascularization second ary to age-related macular degeneration (AMD). Herein, we determine the cos t-effectiveness of PDT for the treatment of subfoveal choroidal neovascular ization (CNV) in patients with disciform degeneration in one eye and whose second and better-seeing eye develops visual loss secondary to predominantl y classic subfoveal CNV. The analysis was performed from the perspective of a for-profit third-party insurer. Design: Cost-utility Markov models were created to determine the cost-effec tiveness of PDT under two different scenarios, by using efficacy data deriv ed from the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study and patient-based utilities. Methods: Decision analyses were performed by incorporating data from the TA P Study, expected longevity data, and patient-based utilities. Cost-effecti ve models were then created by incorporating incremental medical costs. Var ious sensitivity analyses were carried out to determine the robustness of o ur models. A Monte Carlo simulation was also used to determine whether ther e was a significant difference in quality-of-life adjusted years (QALYs) ga ined between PDT therapy and the placebo. Results: For the hypothetical patient whose second and better-seeing eye be comes affected and who has 20/40 vision at baseline in this affected eye (b ase case 1), PDT was associated with a 10.7% relative increase in their qua lity-of-life (treatment conferred an additional undiscounted 0.1342 QALYs o ver a 2-year period). For the hypothetical patient whose second and better- seeing eye becomes affected and who has 20/200 vision at baseline in this a ffected eye (base case 2), PDT was associated with a 7.8% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0 .0669 QALYs over a 2-year period). Sensitivity analysis showed our models w ere robust and that PDT was usually the dominant treatment choice. Our cost -effective model demonstrated that the cost for a QALY was $86,721 (US doll ars discounted at 3%) for base case 1, assuming 5.5 treatments; and $173,98 4 (USD discounted at 3%) for base case 2. Conclusions: PDT will cost a third-party insurer $86,721 for an AMD patient with 20/40 vision in the better-seeing eye to obtain one QALY and $173,984 for an AMD patient with 20/200 vision in the better-seeing eye to obtain o ne QALY. PDT can be considered to be a treatment that is of only minimal co st-effectiveness for AMD patients who have subfoveal CNV in their second an d better-seeing eyes and who have good presenting visual acuity at baseline . It is a cost-ineffective treatment for AMD patients who have poor visual acuities in their affected better-seeing eyes. Ophthalmology 2001;108:2051- 2059 (C) 2001 by the American Academy of Ophthalmology.