The Cot-Utility of Photodynamic Therapy in Eye With Neovacular Macular Degeneration—A Value-Baed Reappraial With 5-Year Data

Purpoe To ae the value conferred by photodynamic therapy (PDT) and the cot-utility of PDT for the treatment of claic, ubfoveal choroidal neovacularization aociated with age-related macular degeneration (ARMD). Deign Average cot-utility analyi utilizing clinical trial data, patient-baed time tradeoff utility preference, and a third party inurer cot perpective. Method Five-year viual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Invetigation were modeled into a 12-year, value-baed, reference cae, cot-utility model utilizing year 2004 Medicare cot and an outcome of $/QALY (dollar/quality-adjuted life-year). Dicounting of outcome and cot uing net preent value analyi with a 3% annual rate wa performed a recommended by the Panel for Cot-Effectivene in Health and Medicine. Reult PDT with verteporfin (Viudyne) dye for claic ubfoveal choroidal neovacularization confer an 8.1% quality of life (value) improvement over the 12-year life expectancy of the reference cae, while during the lat 8 year the value improvement i 9.5%. The average cot-utility of the intervention i $31,103/QALY (quality-adjuted life-year). Extenive one-way enitivity analyi value range from $20,736/QALY if treatment efficacy i increaed by 50% to $62,207 if treatment efficacy i decreaed by 50%, indicating robutne of the model. Concluion PDT uing verteporfin dye to treat claic ubfoveal choroidal neovacularization i a very cot-effective treatment by conventional tandard. The marked improvement in cot-effectivene compared with a previou report reult from the fact that the treatment benefit increaingly accrue during 5 year of follow-up while the number of yearly treatment diminihe markedly during that time