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Table 11 Sensitivity analysis

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

Cost perspec-

tive

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

Genetic testing/monitoring medical costsa (000s)

Negative costs (000s)

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

Overall cost (direct medical + negative costs per patient tested

QALY gain per patient

$/QALY

$500 cost for genetic testing, screening at age 65

 Societal

4.1 % (6,634)

$754,576

(−$1,508,464)

(−$839,978)

(−$890)

0.0043

(−$321,506)

 3rd party

10.1 % (16,504)

$754,576

(−$675,036)

(−$79,540)

(−$84)

0.0103

(−$26,389)

$1000 cost for genetic testing, screening at age 65

 Societal

4.1 % (6634)

$1,226,776

(−$1,508,464)

(−$281,688)

(−$298)

0.0042

(−$71,047)

 3rd party

10.1 % (16,504)

$1,226,776

(−$675,036)

$551,740

$584

0.0103

$56,744

Patient value unchanged, change age of screening from 65 to 60 years

 Societal

4.1 % (6634)

$2,817,145

(−$1,508,464)

$1,312,591

$1390

0.0042

$330,075

 3rd party

10.1 % (16,504)

$2,817,145

(−$675,036)

$2,142,109

$2,269

0.0103

$220,291

Patient value unchanged, change age of screening from 65 to 52 years

 Societal

4.1 % (6634)

$3,787,988

(−$1,508,464)

$2,279,524

$2415

0.0042

$574,940

 3rd party

10.1 % (16,504)

$3,787,988

(−$675,036)

$3,112,952

$3,298

0.0103

$320,167

Patient value unchanged, change age of screening from 65 to 40 year

 Societal

4.1 % (6634)

$5,823,170

(−$1,508,464)

$4.314,706

$4571

0.0042

$1,088,253

 3rd party

10.1 % (16,504)

$5,823,170

(−$675,036)

$5,148,134

$5454

0.0103

$529,469

No extra eye exams and OCT in addition to two annual visits, screening at age 65

 Societal

4.1 % (6634)

$1,800,026

(−$1,508,464)

$291,562

$309

0.0042

$73,538

 3rd party

10.1 % (16,504)

$1,800,026

(−$675,036)

$1,124,990

$1192

0.0103

$115,702

Four extra eye exams and OCT’s in addition to two annual visits, screening at age 65

 Societal

4.1 % (6634)

$3,211,904

(−$1,508,464)

$1,703,440

$1804

0.0042

$429,641

 3rd party

10.1 % (16,504)

$3,211,904

(−$675,036)

$2,536,868

$2687

0.0103

$250,909

Early-treatment ranibizumab cases receive twice as many injections over the first 2 years of therapy than late treatment casers, screening at age 65

 Societal

4.1 % (6634)

$2,667,392

(−$1,508,464)

$1,072,038

$1136

0.0042

$270,591

 3rd party

10.1 % (16,504)

$2,667,392

(−$675,036)

$1,992,356

$2111

0.0103

$204,907

  1. Cost-utility (cost-effectiveness) ratios for Category 3 AMD patients screened for neovascular AMD resulting in incremental, early-treatment ranibizumab therapy (2012 US real dollars, combined-eye model [18–20, 22])
  2. A negative cost-utility ratio (parentheses) indicates that early-treatment dominates late treatment, meaning that early-treatment accrues greater QALYs and has a positive financial return-on-investment
  3. NVAMD neovascular Age-related macular degeneration, QALY quality-adjusted life-year, $/QALY cost-utility ratio, or dollars expended/gained per QALY gained from genetic testing, US United States informal upper limit for cost-effectiveness, WHO World Health Organization upper limit for cost-effectiveness = 3× Gross Domestic Product per capita, AMD age-related macular degeneration, 3rd party third party insurer cost perspective, integrating all incremental direct medical costs associated with genetic screening for neovascular AMD, Societal societal cost perspective, including all direct ophthalmic medical, direct non-ophthalmic medical, direct non-medical (caregiver) and indirect medical (employment) costs
  4. aCosts associated with genetic screening, =$1906 for screening for each Category 3 AMD patient and $299 for 1 extra annual examination and optical coherence tomography scan for the 22 Category 3 AMD patients with a high risk genetic profile
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International Journal of Retina and Vitreous

ISSN: 2056-9920

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