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