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Table 7 Patient value gain from genetic screening-enabled, early-treatment ranibizumab therapy for neovascular AMD, integrating first-eye and second-eye MARINA Study models

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

Cohort [18, 20, 23]

Mean vision at 12, 24, and LOCF to 144 months

Utility at 12, 24, and LOCF to 144 months

12-year

QALY accrual

Per early-treatment patient

QALY gain (QOL gain) integrating conversion of 2nd eyes to NVAMD without adjustments

Per early-treatment patient

QALY gain (QOL gain) (adjusting for 1st eye and 2nd eye, 78.0 % × 62.2 %, with 90 % gene testing sensitivity)

12 months

Sham 24 months

96 months (baseline vision = 20/40–20/80)

20/126

20/160−2

20/640

0.682

0.657

0.538

5.990

0.0 (0.0 %)

0.0 (0.0 %)

Early ranibizumab treatment (mean baseline vision = 20/40–20/80)

20/40−1

0.789

7.924

1.933 (32.8 %)

0.845 (14.1 %)

Late ranibizumab treatment (mean baseline vision = ≤20/160)

20/160+2

0.658

6.561

0.571 (9.5 %)

0.250 (4.2 %)

Incremental gain, early vs. late ranibizumab treatment patient made possible by genetic testing

NA

0.141

1.363

1.363 (23.3 %)

0.595 (10.0 %)

Cohort

NA

NA

12-year

QALY accrual

Per screened patient

QALY gain (QOL gain) integrating 2nd eye conversion to NVAMD

Per screened patient QALY gain (QOL gain) (adjusting for 1st eye and 2nd eye, 78.0 % × 62.2 %, with 90 % gene testing sensitivity)

Incremental gain, per patient genetic screened/monitored for NVAMD

NA

NA

0.0432

0.0432 (0.71 %)

0.0185 (0.33 %)

  1. LOCF last observation carried forward, QOL quality-of-life, QALY quality-adjusted life-year, NA not applicable, NVAMD neovascular age-related macular degeneration