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Table 10 3rd party insurer, cost-utility ratios for Category 3 [5] age-related macular degeneration patients undergoing genetic testing for progression to neovascular AMD

From: A Value-Based Medicine cost-utility analysis of genetic testing for neovascular macular degeneration

Incremental % of patients undergoing early-treatment ranibizumab therapy due to genetic testing (# of patients)

Genetic testing/moni-toring medical costsa (000s)

Negative costsa (000s)

Total costs (direct medical + negative costs (000s)

Overall cost (direct medical + negative costs) per patient tested

QALY gain per patient screened

$/QALY

1 % (1618)

$2,082,402

(−$66,180)

$2,016,222

$2135

0.0010

$2,094,915

2 % (3235)

$2,082,402

(−$132,360)

$1,950,042

$2065

0.0020

$1,013,076

3 % (4853)

$2,082,402

(−$198,540)

$1,883,862

$1995

0.0031

$652,463

4 % (6479)

$2,082,402

(−$264,720)

$1,817,682

$1925

0.0041

$472,156

5 % (8088)

$2,082,402

(−$330,900)

$1,751,502

$1855

0.0051

$363,973

10 % (16,175)

$2,082,402

(−$661,800)

$1,420,602

$1504

0.0102

$147,605

10.1 % (16,504)

$2,082,402

(−$675,036)

$1,407,366

$1479

0.0103

$144,000

13.2 % (21,358)

$2,082,402

(−$878,341)

$1,204,061

$1350

0.0135

$100,000

15 % (24,263)

$2,082,402

(−$992,700)

$1,089,702

$1154

0.0153

$75,482

20 % (32,351)

$2,082,402

(−$1,323,600)

$758,801

$803

0.0204

$39,421

30 % (48,526)

$2,082,402

(−$1,985,400)

$97,001

$103

0.0306

$3,360

34.6 % (56,048)

$2,082,402

(−$2,293,138)

(−$210,736)

(−$223)

0.0353

(−$6,319)

38.5 % (62,275)

$2,082,402

(−$2,547,931)

(−$465,529)

(−$493)

0.0392

(−$12,564)

  1. The societal costs perspective included the following costs: (a) direct ophthalmic medical costs, (b) direct non-ophthalmic medical costs (depression, trauma, skilled nursing facility, nursing home, other Medicare costs) + caregiver costs + employment costs saved by genetic testing leading to early-treatment, versus late-treatment, of neovascular age-related macular degeneration with intravitreal ranibizumab
  2. Direct non-ophthalmic medical costs = costs for depression, trauma, skilled nursing facilities, nursing homes and other Medicare costs
  3. The model is a combined-eye model integrating the patient value gain and costs associated with first-eye (78.0 % presenting with vision <20/160) and second-eye (62.2 % of eyes presenting with 20/20/160 vision) ranibizumab therapy for neovascular AMD, assuming genetic testing identifies 90 % of cases that will progress to neovascular age-related macular degeneration
  4. A negative cost-utility ratio () indicates that early-treatment dominates late treatment, meaning that early-treatment accrues greater QALYs and has a positive financial return-on-investment (QALY quality-adjusted life-year, $/QALY cost-utility ratio, or dollars expended/gained per QALY gained from genetic testing, AMD age-related macular degeneration)
  5. aDirect ophthalmic medical costs = costs associated with genetic screening, including $1906 for screening and $299 for 1 extra annual examination and optical coherence tomography scan for the 22.5 % of Category 3 AMD patients with a high risk genetic profile for progression to neovascular age-related macular degeneration
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International Journal of Retina and Vitreous

ISSN: 2056-9920

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