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Table 9 Societal, cost-utility ratios for category 3 [5] age-related macular degeneration (AMD) patients undergoing genetic testing to predict progression to neovascular AMD

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

Incremental % of patients undergoing early-treatment ranibizumab therapy due to genetic testing (# of patients) Genetic testing/moni-toring medical costsa (000s) Negative costsa (000 s) Total costs (direct medical + negative costs (000s) Overall cost (direct medical + negative costs) per patient tested QALY gain per patient screened $/QALY
1 % (1618) $2,082,402 (−$367,918) $1,714,484 $1815 0.0010 $1,781,400
2 % (3235) $2,082,402 (−$735,835) $1,346,567 $1426 0.0020 $699,562
3 % (4853) $2,082,402 (−$1,103,752) $978,649 $1036 0.0031 $338,949
4 % (6470) $2,082,402 (−$1,471,670) $610,732 $647 0.0041 $158,642
4.1 % (6634) $2,082,402 (−$1,508,464) $573,938 $605 0.0042 $144,000
4.5 % (7119) $2,082,402 (−$1,607,802) $474,600 $450 0.0045 $100,000
5 % (8088) $2,082,402 (−$1,839,588) $242,814 $257 0.0051 $50,458
10 % (16,175) $2,082,402 (−$3,679,175) (−$1,596,774) (−$1691) 0.0102 (−$165,910)
15 % (24,263) $2,082,402 (−$5,518,763) (−$3,436,361) (−$3639) 0.0153 (−$238,032)
20 % (32,351) $2,082,402 (−$7,358,351) (−$5,275,949) (−$5587) 0.0204 (−$274,093)
30 % (48,526) $2,082,402 (−$11,037,527) (−$8,955,125) (−$9482) 0.0306 (−$310,155)
34.6 % (56,048) $2,082,402 (−$12,738,343) (−$10,665,141) (−$11,294) 0.0353 (−$319,834)
38.5 % (62,275) $2,082,402 (−$14,164,826) (−$12,082,424) (−$12,794) 0.0392 (−$326,078)
  1. The societal costs perspective included the following costs: (a) direct ophthalmic medical costs, (b) direct non-ophthalmic medical costs (depression, trauma, skilled nursing facility, nursing home, other Medicare costs) + caregiver costs + employment costs saved by genetic testing leading to early-treatment, versus late-treatment, of neovascular age-related macular degeneration with intravitreal ranibizumab
  2. Direct non-ophthalmic medical costs = costs for depression, trauma, skilled nursing facilities, nursing homes and other Medicare costs
  3. The model is a combined-eye model integrating the patient value gain and costs associated with first-eye (78.0 % presenting with vision <20/160) and second-eye (62.2 % of eyes presenting with 20/20/160 vision) ranibizumab therapy for neovascular AMD, assuming genetic testing identifies 90 % of cases that will progress to neovascular age-related macular degeneration
  4. A negative cost-utility ratio () indicates that early-treatment dominates late treatment, meaning that early-treatment accrues greater QALYs and has a positive financial return-on-investment
  5. QALY quality-adjusted life-year, $/QALY cost-utility ratio, or dollars expended/gained per QALY gained from genetic testing
  6. aDirect ophthalmic medical costs = costs associated with genetic screening, including $1906 for screening and $299 for 1 extra annual examination and optical coherence tomography scan for the 22.5 % of Category 3 AMD patients with a high risk genetic profile for progression to neovascular age-related macular degeneration