Abstract
IntroductionThe estimation of utility values for the economic evaluation of therapies for wet age-related macular degeneration (AMD) is a particular challenge. Previous economic models in wet AMD have been criticized for failing to capture the bilateral nature of wet AMD by modelling visual acuity (VA) and utility values associated with the better-seeing eye only.MethodsHere we present a de novo regression analysis using generalized estimating equations (GEE) applied to a previous dataset of time trade-off (TTO)-derived utility values from a sample of the UK population that wore contact lenses to simulate visual deterioration in wet AMD. This analysis allows utility values to be estimated as a function of VA in both the better-seeing eye (BSE) and worse-seeing eye (WSE).ResultsVAs in both the BSE and WSE were found to be statistically significant (p < 0.05) when regressed separately. When included without an interaction term, only the coefficient for VA in the BSE was significant (p = 0.04), but when an interaction term between VA in the BSE and WSE was included, only the constant term (mean TTO utility value) was significant, potentially a result of the collinearity between the VA of the two eyes. The lack of both formal model fit statistics from the GEE approach and theoretical knowledge to support the superiority of one model over another make it difficult to select the best model.ConclusionLimitations of this analysis arise from the potential influence of collinearity between the VA of both eyes, and the use of contact lenses to reflect VA states to obtain the original dataset. Whilst further research is required to elicit more accurate utility values for wet AMD, this novel regression analysis provides a possible source of utility values to allow future economic models to capture the quality of life impact of changes in VA in both eyes.FundingNovartis Pharmaceuticals UK Limited.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0620-x) contains supplementary material, which is available to authorized users.
Highlights
The estimation of utility values for the economic evaluation of therapies for wet age-related macular degeneration (AMD) is a particular challenge
Wet AMD leads to a progressive loss of visual acuity (VA; the ability of the eye to resolve fine detail) which affects the capacity to which patients can continue with routine activities such as driving, reading, and recognizing faces, and can have a substantial impact on health-related quality of life (HRQoL) [2, 3]
In the United Kingdom (UK), measurement of HRQoL is an important aspect of the clinical benefit of novel therapies, where cost-utility analysis is the preferred method of health technology assessment (HTA) recommended by the National Institute of Health and Care Excellence (NICE) to assess the relative value of novel interventions to the UK National Health Service (NHS) [4]
Summary
The estimation of utility values for the economic evaluation of therapies for wet age-related macular degeneration (AMD) is a particular challenge. Wet AMD leads to a progressive loss of visual acuity (VA; the ability of the eye to resolve fine detail) which affects the capacity to which patients can continue with routine activities such as driving, reading, and recognizing faces, and can have a substantial impact on health-related quality of life (HRQoL) [2, 3]. In the United Kingdom (UK), measurement of HRQoL is an important aspect of the clinical benefit of novel therapies, where cost-utility analysis is the preferred method of health technology assessment (HTA) recommended by the National Institute of Health and Care Excellence (NICE) to assess the relative value of novel interventions to the UK National Health Service (NHS) [4]. NICE’s preferred generic preference-based method of utility value elicitation is the EuroQol Health Questionnaire 5 Dimensions (EQ-5D)—a patient-reported questionnaire with five domains covering mobility, self-care, usual activities, pain/discomfort, and anxiety/
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