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Table 6 Societal costs (2012 US real dollars) per early-treatment patient from genetic testing/monitoring for neovascular AMD enabling incremental early-treatment (vs. late-treatment) ranibizumab therapy

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

Societal costs per NVAMD patient treated with intravitreal ranibizumab therapy Column A 12-year, societal costs integrating 2nd eye multiplier of 85.7 % Column B 12-year, societal costs adjusted for 1st and 2nd eye = 48.5 % × 90 % gene testing sensitivitya Column C 12-year, direct medical costs, adjusted as in Column B
Direct ophthalmic medical costs (genetic testing/monitoring of patients) A. $66,873 (per incremental early-treatment ranibizumab case) A. $66,873 (per incremental early-treatment ranibizumab case) A. $66,873 (per incremental early-treatment ranibizumab case)
Genetic screening for Category 3 AMD patients with one ranibizumab-facilitated early-treatment case per 30.3 screened cases $57,805 $57,805 $57,805
1 more ocular (exam/OCT)/year in high-risk genetic cases (22.5 % of Category 3 cases) $9068 $9068 $9068
Direct non-ophthalmic medical costs [39] B. (−$93,699) B. (−$40,914) B. (−$40,914)
 Decreased depressionb (−$7169) (−$3130) (−$3130)
 Decreased injuriesb (−$3793) (−$1656) (−$1656)
 Decreased nursing home admissionsb (−$22,351) (−$9759) (−$9759)
 Less skilled nursing facility (SNF) costsb (−$10,193) (−$4451) (−$4451)
 Other decreased Medicare costsb (−$50,194) (−$21,917) (−$21,917)
Direct non-medical costs (caregiver costs)b [40] (−$394,929) (−$172,443) NA
Indirect medical costs (employment costs)b [41] (−$32,288) (−$14,098) NA
Total negative costs (−$520,917) (−$227,455) (−$40,914)
Total costs (−$454,044) (−$160,582) $25,960
  1. Societal real costs = direct ophthalmic medical costs, direct non-ophthalmic medical costs, direct non-medical costs and indirect medical costs. Cost savings are assumed to accrue beginning at month 7 after the initiation of intravitreal ranibizumab therapy. All costs are discounted at 3 %/year
  2. NVAMD neovascular AMD, OCT optical coherence tomogram
  3. aFirst eyes: 78 % of first eyes (with initial vision <20/160) adjusted for conversion to NVAMD in 2nd eyes × (85.3 % multiplier); second eyes: 62.2 % with <20/160 vision; 90 % = gene testing/clinical sign sensitivity for detecting future NVAMD
  4. bNegative cost