Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Retina. 2010 Feb;30(2):212-21. doi: 10.1097/IAE.0b013e3181babd8e.
The purpose of this study was to evaluate the cost effectiveness of pegaptanib sodium and ranibizumab injections compared with photodynamic therapy (PDT) with verteporfin for the treatment of choroidal neovascularization secondary to age-related macular degeneration.
The analyses were performed using outcomes data from the pivotal trials for each treatment and the medicare reimbursable costs for each treatment and associated medical procedures. A multistate transition model with 3-month cycles was created to compare incremental medical costs associated with pegaptanib or ranibizumab versus PDT for patients with starting vision of 20/40, 20/80, and 20/200 Snellen equivalent.
Two-year medical treatment costs ranged from $3,100 to $54,100 depending on treatment and lesion type. Photodynamic therapy was less costly and more effective than pegaptanib for predominantly classic and minimally classic lesions. Ranibizumab was not only more effective but also more costly than PDT for all lesion types.
Compared with PDT, pegaptanib is inferior in both cost and effectiveness, whereas ranibizumab has a greater effectiveness. Because ranibizumab does not meet 1 of the common thresholds for being considered cost effective (<$50,000 per quality-adjusted life year), there is rationale to seek other therapies that are more cost effective.
本研究旨在评估与光动力疗法（PDT）联合维替泊芬相比，用于治疗年龄相关性黄斑变性继发脉络膜新生血管的聚乙二醇化人脉络膜血管生成素钠（商品名：Macugen）和雷珠单抗注射剂的成本效果。
使用每种治疗方法的关键性试验结果数据以及每种治疗方法和相关医疗程序的医疗保险报销费用进行分析。创建了一个具有 3 个月周期的多状态转移模型，以比较 20/40、20/80 和 20/200 斯耐伦等效视力起始的患者中，与 PDT 相比，聚乙二醇化人脉络膜血管生成素钠或雷珠单抗的增量医疗成本。
根据治疗和病变类型，两年的医疗治疗费用在 3100 美元至 54100 美元之间不等。PDT 比聚乙二醇化人脉络膜血管生成素钠对于主要经典和最小经典病变更具成本效益。对于所有病变类型，雷珠单抗不仅比 PDT 更有效，而且成本更高。
与 PDT 相比，聚乙二醇化人脉络膜血管生成素钠在成本和效果上均较差，而雷珠单抗则具有更好的效果。由于雷珠单抗不符合被认为具有成本效果（<50000 美元/质量调整生命年）的常见标准之一，因此有理由寻找更具成本效果的其他疗法。
