Abstract
BackgroundAge-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system.ObjectiveTo conduct a budget impact analysis of three scenarios for the introduction of AMD treatments: all the medications (verteporfin, ranibizumab, and bevacizumab–the reference scenario), ranibizumab alone, and bevacizumab alone.MethodsThe basic assumption was that the Brazilian public health system would treat the entire target population with AMD aged > 70 years between 2008 and 2011. The size of the population of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procurement policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the reference scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analyses were run to check the robustness of the model.ResultsIn four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 for bevacizumab, US$11,469.39 for ranibizumab, and US$4,376.28 for verteporfin. The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period. The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.ConclusionThe introduction of bevacizumab for the treatment of AMD is recommended for the Brazilian Public Health System.
Highlights
Age-related macular degeneration (AMD) is a degenerative disease that causes severe visual loss and blindness
We carried out a budget impact analysis (BIA), which followed the methodological guidelines recommended by the Brazilian Ministry of Health [6] and by MAUSKOPF et al [7]
This study indicated that the best alternative to introducing all three existing treatments for neovascular AMD to the Brazilian public health system would have been to introduce bevacizumab alone, since it would have yielded considerable financial savings
Summary
Age-related macular degeneration (AMD) is a degenerative disease that causes severe visual loss and blindness. The risk factors for AMD are increasing age, cigarette smoking, prior cataract surgery, and family history [3]. This disease is ranked third among the global causes of visual impairment, with a blindness prevalence of 8.70% in individuals aged > 50 years according to the World Health Organization [4]. There are two types of macular degeneration: dry (nonexudative or atrophic) and wet (neovascular or exudative) The latter is the target of the current treatments, which focus on attenuating choroidal neovascularization activity [1], slowing the progress of the disease. The new treatment options for AMD are not provided by the Brazilian public health system
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