Duke-NUS Medical School, Singapore, Singapore.
Singapore National Eye Centre, Singapore, Singapore.
Eye (Lond). 2022 Dec;36(12):2265-2270. doi: 10.1038/s41433-021-01856-9. Epub 2021 Nov 22.
For patients with polypoidal choroidal vasculopathy (PCV), intravitreal anti-vascular endothelial growth factor (anti-VEGF) combination therapy has been shown to be cost-saving relative to monotherapy in a clinical trial setting. However, whether this also applies to real-world settings is unclear. We aim to compare the real-world functional outcomes and cost-effectiveness of intravitreal anti-VEGF combination therapy relative to monotherapy, to investigate whether combination therapy is truly cost-saving.
We used a Markov model to simulate a hypothetical cohort of PCV patients treated at Singapore National Eye Centre. Model parameters were informed by coarsened exact matched estimates of a two-year retrospective study of patients who initiated treatment in 2015. Treatment options included intravitreal aflibercept, bevacizumab, or ranibizumab, as monotherapy or in combination with full-fluence verteporfin photodynamic therapy.
The two-year logMAR letters gains were significant for combination therapy ( + 10.6, P = 0.006) but not monotherapy (-2.2, P = 0.459). Over 20 years, a PCV patient would cost the health system SGD 48,790 under monotherapy and SGD 61,020 under combination therapy. Quality-adjusted life-years (QALYs) were estimated to be 7.41 for monotherapy and 7.80 for combination therapy. The incremental cost-effectiveness ratio of combination therapy was SGD 31,460/QALY, which is less than the common willingness-to-pay threshold of per capita gross domestic product of Singapore (SGD 88,990/QALY). Sensitivity analysis showed that combination therapy remained incrementally cost-effective, but not cost-saving.
Our study shows that combination therapy is good value for money but is likely to increase costs when applied in real-world settings.
对于息肉样脉络膜血管病变（PCV）患者，临床试验表明，与单药治疗相比，玻璃体内抗血管内皮生长因子（anti-VEGF）联合治疗具有成本效益。然而，这是否也适用于真实环境尚不清楚。我们旨在比较玻璃体内抗 VEGF 联合治疗与单药治疗的真实世界功能结局和成本效益，以研究联合治疗是否真正具有成本效益。
我们使用马尔可夫模型模拟了在新加坡国家眼科中心接受治疗的 PCV 患者的假设队列。模型参数来自于对 2015 年开始治疗的患者进行的为期两年的回顾性研究的粗化精确匹配估计。治疗选择包括玻璃体内阿柏西普、贝伐单抗或雷珠单抗单药治疗或与全强度维替泊芬光动力疗法联合治疗。
联合治疗两年的 logMAR 字母增益显著（+10.6，P=0.006），而单药治疗则不显著（-2.2，P=0.459）。在 20 年内，PCV 患者在单药治疗下的医疗系统成本为 48790 新元，在联合治疗下为 61020 新元。估计质量调整生命年（QALY）分别为单药治疗 7.41 年和联合治疗 7.80 年。联合治疗的增量成本效益比为 31460 新元/QALY，低于新加坡人均国内生产总值（SGD 88990/QALY）的常见支付意愿阈值。敏感性分析表明，联合治疗仍然具有增量成本效益，但不具有成本效益。
我们的研究表明，联合治疗具有良好的性价比，但在真实环境中应用时可能会增加成本。
