Cost-effectiveness of autologous retinal pigment epithelium and choroid translocation in neovascular AMD.

Abstract

To assess the cost-effectiveness of autologous retinal pigment epithelium and choroid translocation (PATCH) in neovascular age-related macular degeneration (AMD). Visual acuity and complication rates of published patient series were used to determine the incremental utility of treatment for the patient. The utility data applied assume that the better eye was affected. Comparator was a meta-analysis of recent control groups, in which patients received best supportive care. To assess cost-effectiveness, costs per quality adjusted life years (QALYs) and costs of avoiding low vision ("legal blindness", i.e. ≤20/200) were calculated. Costs were based on a German sick fund perspective and in a scenario on US costs. Robustness of the model was investigated by univariate and probabilistic multivariate sensitivity analysis (PSA). Cost-utility analysis showed surgery to be the dominant ("cost-saving") strategy for Germany and for the US in both, cost-effectiveness and cost-utility analysis (costs per QALY). In the sensitivity analysis the intervention remained dominant or cost-effective in all scenarios investigated. Clinical outcomes and duration of modeling were the most influential factors in the sensitivity analyses. Therapy of neovascular AMD by PATCH is a cost-effective treatment option for selected patients, who are not well suitable for other current treatment options.