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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 [1820, 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