Objective: To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization.
Design: Computer-based econometric modeling.
Methods: The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money.
Database: Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis.
Intervention: Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration.
Main outcome measure: Cost per quality-adjusted life-year ($/QALY gained) associated with laser therapy.
Results: Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant $/QALY gained was $5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a $/QALY gained of $4974 with no gained discount rate and $11,633 with a yearly discount rate of 10%.
Conclusions: The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.