Cost-effectiveness analysis of individualized versus standardized anti-VEGF therapy in AMD patients
Author
Roer, Maria Klit Muldbak
Term
4. term
Publication year
2013
Submitted on
2013-05-31
Pages
18
Abstract
Aldersrelateret makuladegeneration (AMD) er den største årsag til synstab blandt personer på 60 år eller derover i de udviklede lande. Behandlingen har traditionelt fulgt en fast plan, men nyere viden peger på, at en individuelt tilpasset tilgang kan være bedre. Formålet var at sammenligne omkostninger og helbredsmæssige konsekvenser ved to måder at give anti-VEGF-injektioner på: en standardiseret serie på tre injektioner til alle versus en individualiseret “behandl efter indikation”-strategi, hvor der kun gives injektioner, når der er behov. Anti-VEGF er lægemidler, der sprøjtes ind i øjet for at hæmme et vækststof, som kan føre til skadelige blodkar. Metode: Vi kombinerede statistisk proceskontrol (SPC), som er en metode til at overvåge en behandlingsproces over tid, med en omkostningseffektivitetsanalyse (CEA), der sammenligner omkostninger og helbredsgevinster. Beslutningsmodellen begyndte ved patientens første injektion eller kontrolbesøg, og effektmålet var undgåede infektioner. En probabilistisk sensitivitetsanalyse (PSA) blev brugt til at teste, hvor robuste resultaterne var over for usikkerhed. Resultater: SPC viste et fald i antallet af injektioner efter indførelsen af den individualiserede strategi. CEA estimerede en omkostningsbesparelse på 5 % og en sandsynlighed på 0,133 % for undgåede infektioner. Konklusion: Den individualiserede behandling fremstår som den foretrukne strategi, fordi den både reducerer omkostninger og kan forbedre kvaliteten. Da SPC-processen var ustabil, anbefales yderligere evaluering.
Age-related macular degeneration (AMD) is the leading cause of vision loss in people aged 60 and over in developed countries. Treatment has traditionally followed a fixed plan, but recent evidence suggests that a tailored approach may work better. This study compared the costs and health consequences of two ways to give anti-VEGF injections: a standardized course of three injections for everyone versus an individualized “treat by indication” strategy, where injections are given only when needed. Anti-VEGF drugs are injected into the eye to block a growth factor that can promote harmful blood vessels. Methods: We combined statistical process control (SPC), a way to monitor how care performs over time, with a cost-effectiveness analysis (CEA) that compares costs and health gains. The decision model started at the patient’s first injection or control visit, and the effect was measured as infections averted. A probabilistic sensitivity analysis (PSA) tested how robust the findings were to uncertainty. Results: SPC showed a drop in the number of injections after the individualized strategy was introduced. The CEA estimated a 5% cost saving and a 0.133% probability of infections averted. Conclusion: Individualized therapy appears to be the preferred strategy because it reduces costs and may improve quality. However, because the SPC process was unstable, further evaluation is recommended.
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