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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