OBJECTIVE: To develop a health-economic assessment for Macugen, a new treatment for age-related macular degeneration (AMD). A comprehensive model compares Macugen (pegaptanib sodium), indicated for all patients with neovascular AMD, relative to the existing photodynamic therapy with Visudyne (verteporfin).
METHODS: A Markov framework was used to model the lifetime movement of an AMD cohort through five health states based on visual acuity (VA): >20/40, 20/40 to >20/80, 20/80 to >20/200, 20/200 to >20/400, and °Ü20/400. The model incorporates patients across all lesion subtypes: predominately classic, minimally classic, and occult. All drug and procedure costs were derived from US published sources, including Medicare Part B Drugs Average Sales Price and RBRVS. Expert interviews were conducted to determine adverse events treatment patterns and vision rehabilitation resource use. Relative risks and costs associated with effects associated with declining VA (depression, bone fractures, skilled nursing facilities, and nursing homes) were extracted from a Medicare analysis. Transition probabilities were derived from published trial data for both products for each of the 3-month cycles. Utilities were derived from similar published sources as previous AMD models. Results are expressed as vision years, quality-adjusted life years (QALYs), medical costs and other costs, as well as the average cost per vision year and QALY gained.
RESULTS: For a lifetime analysis the average cost per vision year was $20,459 for Macugen and $26,079 for Visudyne and the average cost per QALY was $19,609 for Macugen and $20,136 for PDT. A patient treated with Macugen had on average 3.68 vision years over a lifetime compared to 2.65 for a patient treated with Visudyne.
CONCLUSIONS: Macugen treatment produces more years of sight than Visudyne for AMD treated patients. Macugen is more cost-effective versus active treatment with Visudyne. A limitation of the model is the absence of direct clinical comparison between the products.
