Department of Ophthalmology, Massachusetts Eye and Ear and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Retina. 2024 Jan;8(1):25-31. doi: 10.1016/j.oret.2023.08.003. Epub 2023 Aug 11.
To evaluate the cost-effectiveness of the treatment of geography atrophy (GA) with intravitreal pegcetacoplan and to identify utility-measurement surrogates.
Cost analysis based on data from a published study.
None; based on data from published sham control compared with 2 treatment groups in the index study.
Costs were based on 2022 Medicare reimbursement data. Specific outcomes were extrapolated from the DERBY and OAKS trials. Assumptions were made for the lifetime analysis based on a theoretical logistic growth model of the atrophy.
Cost, cost utility, cost per quality-adjusted life-year, and cost per area of GA (in US$).
The costs to treat GA in every month (EM) and every-other-month (EOM) treatment groups over the 2 years as reported were $70 000 and $34 600, respectively. The costs per area of delaying GA for 2 years in all patients were $87 300/mm (EM) and $49 200/mm (EOM), and in initially extrafoveal patients, $53 900/mm (EM) and $32 100/mm (EOM). The costs per day of delaying GA for 2 years were $295 (EM) and $170 (EOM); the marginal cost (EM vs. EOM) per retinal pigment epithelium cell saved was $30. The modeled lifetime costs were $350 000 (EM) and $172 000 (EOM), or $309 000/mm (EM) and $180 000 (EOM) /mm. The modeled time to 95% atrophy at 13 years was delayed by 2.5 years (EM) and 2.1 years (EOM). The costs/quality-adjusted life-year gained based on modeled visual loss with 95% atrophy were $706 000 (EM) and $397 000 (EOM).
Treatment of GA with intravitreal pegcetacoplan EOM was more cost effective than EM. Treatment of extrafoveal lesions yielded greater utility than the treatment of the entire group. As atrophy progression approaches an upper limit, the marginal cost/benefit ratios increase.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
评估玻璃体内注射培格司他单抗治疗地图状萎缩（GA）的成本效益，并确定效用测量替代指标。
基于已发表研究数据的成本分析。
无；基于索引研究中已发表的假对照与 2 个治疗组的数据。
基于 2022 年医疗保险报销数据计算成本。具体结果从 DERBY 和 OAKS 试验中推断得出。基于萎缩的理论逻辑增长模型对终生分析进行了假设。
成本、成本效用、每质量调整生命年成本和每 GA 面积成本（美元）。
在 2 年内，每月（EM）和每两个月（EOM）治疗组的治疗 GA 成本分别为 70000 美元和 34600 美元。所有患者延迟 GA 2 年的每面积成本分别为 87300 美元/毫米（EM）和 49200 美元/毫米（EOM），以及初始中心外患者为 53900 美元/毫米（EM）和 32100 美元/毫米（EOM）。延迟 GA 2 年的每日成本分别为 295 美元（EM）和 170 美元（EOM）；每挽救一个视网膜色素上皮细胞的边际成本（EM 与 EOM）为 30 美元。终生模型成本分别为 350000 美元（EM）和 172000 美元（EOM），或 309000 美元/毫米（EM）和 180000 美元/毫米（EOM）。在 13 年内，EM 延迟了 2.5 年，EOM 延迟了 2.1 年达到 95%的萎缩。基于 95%萎缩的模型视觉损失，每质量调整生命年的成本/效益比分别为 706000 美元（EM）和 397000 美元（EOM）。
玻璃体内注射培格司他单抗 EOM 治疗 GA 比 EM 更具成本效益。治疗中心外病变的效用大于治疗整个病变组。随着萎缩进展接近上限，边际成本/效益比增加。
本文末尾的脚注和披露中可能会发现专有或商业披露信息。
