Real World Evidence, PharmaQuant, Kolkata, West Bengal, India.
Ophthalmology and Visual Science, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
Value Health. 2022 Oct;25(10):1705-1716. doi: 10.1016/j.jval.2022.07.008. Epub 2022 Aug 31.
Suprachoroidal injection of triamcinolone acetonide is the first Food and Drug Administration-approved treatment for macular edema associated with uveitis. A cost-effectiveness analysis was performed comparing this treatment with best supportive care (BSC) for the management of this indication from US Medicare and commercial payer perspectives.
A patient-level simulation was developed per the patient characteristics and changes in best-corrected visual acuity letter scores observed in a phase III study of triamcinolone acetonide (PEACHTREE). The wholesale acquisition cost of triamcinolone acetonide was $1650/injection; suprachoroidal injection cost was assumed at $200/injection. Healthcare costs were informed by a US claims-based analysis. Mortality risk associated with severe vision loss and blindness was modeled by applying a hazard ratio to all-cause mortality rates of the US general population. Health-related quality of life weights, obtained from a regression model fitted to the Visual Function Questionnaire-25 data from PEACHTREE, were applied based on the best-corrected visual acuity scores of both eyes. Costs (2020 US dollar) and benefits were discounted at 3% annually. Incremental cost-effectiveness ratios were estimated over a 10-year horizon.
In the base-case, the incremental cost-effectiveness ratio comparing triamcinolone acetonide with BSC was $28 479 per quality-adjusted life-year gained. The wholesale acquisition cost for triamcinolone acetonide for suprachoroidal use was ∼68%, ∼56%, and ∼27% below the willingness-to-pay thresholds of $150 000, $100 000, and $50 000 per quality-adjusted life-year gained, respectively. Results were robust in sensitivity and scenario analyses.
Triamcinolone acetonide for suprachoroidal use is cost-effective compared with BSC for patients with macular edema associated with uveitis.
曲安奈德经巩膜睫状体腔注射是首个获得美国食品药品监督管理局批准用于治疗葡萄膜炎相关黄斑水肿的药物。本研究从美国医疗保险和商业支付者的角度，采用成本效果分析法比较了该药物与最佳支持治疗（BSC）在该适应证中的疗效。
根据曲安奈德治疗葡萄膜炎相关黄斑水肿的 III 期 PEACHTREE 研究中患者的特征和最佳矫正视力字母评分的变化，建立了一个患者水平的模拟模型。曲安奈德的批发采购成本为 1650 美元/支；假设巩膜睫状体腔注射的成本为 200 美元/支。医疗保健成本来源于美国基于索赔的分析。通过将美国一般人群的全因死亡率的风险比应用于严重视力丧失和失明的风险，对其进行了建模。应用回归模型对 PEACHTREE 中的视觉功能问卷-25 数据进行拟合，获得健康相关生活质量权重，并根据双眼最佳矫正视力评分进行应用。成本（2020 年美元）和收益均按 3%的年贴现率贴现。在 10 年的时间内估算增量成本效果比。
在基线情况下，与 BSC 相比，曲安奈德治疗的增量成本效果比为每获得 1 个质量调整生命年增加 28479 美元。曲安奈德经巩膜睫状体腔注射的批发采购成本分别约为 150000 美元、100000 美元和 50000 美元每获得 1 个质量调整生命年的意愿支付阈值的 68%、56%和 27%。敏感性分析和情景分析结果稳健。
与 BSC 相比，曲安奈德经巩膜睫状体腔注射治疗葡萄膜炎相关黄斑水肿在成本效果上具有优势。
