THE COMPARATIVE EFFECTIVENESS AND COST-EFFECTIVENESS OF INTRAOCULAR 90Sr BRACHYTHERAPY/INTRAVITREAL VEGF INHIBITOR FOR NEOVASCULAR MACULAR DEGENERATION

To assess the comparative effectiveness and cost-effectiveness of a Phase 2 cohort of participants undergoing intraocular 90Sr brachytherapy/vascular endothelial growth factor inhibitor therapy for neovascular, age-related macular degeneration. Methods A Value-Based Medicine® cost-utility analysis using 2008 US dollars was performed for second-eye, first-eye, and combined-eye models using third party insurer and governmental cost perspectives. Outcomes and costs were discounted at 3%/y. Results Treatment with the combined-eye model confers 0.981 QALY, a 15.8% improvement in quality-of-life over the 13-year cost-utility analysis, whereas the second-eye model confers a 22.4% improvement, and the first-eye model a 12.3% improvement. The combined-eye model, governmental CUR is −$7150/QALY and third party insurer CUR is $10,973/QALY. The second-eye model, governmental cost perspective, cost-utility ratio (CUR) is −$10,290/QALY and the third party insurer CUR is $7728/QALY, whereas the first-eye model, societal CUR is −$3678/QALY, and the third party insurer CUR is $14,202/QALY. Including caregiver costs, the governmental cost perspective, second-eye, first-eye, and combined-eye model CURs are, respectively, −$89,259/QALY, −$82,046/QALY, and −$85,430/QALY. The combined-eye model accrues a net $76,114 per capita Gross Domestic Product, a 16.2% annual return on investment, or an $11.6 billion gain for the US economy over 13 years. Conclusions Preliminary data suggest intraocular 90Sr brachytherapy/vascular endothelial growth factor inhibitor therapy for neovascular age-related macular degeneration confers considerable patient value and is cost-effective. Longer-term data from a larger treatment cohort will allow for a more robust model.