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lüll Pharmacologic management of neovascular age-related macular degeneration: systematic review of economic evidence and primary economic evaluation Hodge W; Brown A; Kymes S; Cruess A; Blackhouse G; Hopkins R; McGahan L; Sharma S; Pan I; Blair J; Vollman D; Morrison ACan J Ophthalmol 2010[Jun]; 45 (3): 223-30OBJECTIVE: To examine the economic implications for the Canadian health system of pharmacologic treatment of neovascular age-related macular degeneration (AMD). DESIGN: Systematic review of economic literature and a primary economic evaluation. PARTICIPANTS: Economic literature search identified 392 potentially relevant articles, 12 of which were included for final review. METHODS: Studies were included if they met the following criteria: (i) provision of a summary measure of the trade-off between costs and consequences; (ii) participants of 40 years and older with neovascular AMD; (iii) interventions and comparators: comparison of photodynamic therapy using verteporfin (V-PDT), pegaptanib, bevacizumab, ranibizumab, anecortave acetate, intravitreal triamcinolone, placebo, or clinically relevant combinations; and (iv) outcome reported as an incremental measure of the implication of moving from the comparator to the intervention. The following databases were searched through the OVID interface: MEDLINE, EMBASE, BIOSIS Previews, CINAHL, PubMed, Health Economic Evaluations Database (HEED), and the Cochrane Library. For the economic evaluation, we took a decision analytic approach and modeled a cost-utility analysis, conducting it as a microsimulation of a Markov model. RESULTS: In general, V-PDT is more cost effective than conventional macular laser, and pegaptanib is likely more cost effective than V-PDT. The primary economic analysis revealed ranibizumab to be effective but at an unacceptably high cost per quality-adjusted life year (QALY)(>$50,000 per QALY). CONCLUSIONS: Although ranibizumab is effective for wet AMD, its cost is unacceptably high based on cost-utility theory.|Antibodies, Monoclonal, Humanized[MESH]|Antibodies, Monoclonal/administration & dosage/*economics[MESH]|Canada[MESH]|Choroidal Neovascularization/drug therapy/*economics[MESH]|Cost-Benefit Analysis[MESH]|Health Care Costs[MESH]|Humans[MESH]|Markov Chains[MESH]|National Health Programs[MESH]|Quality-Adjusted Life Years[MESH]|Ranibizumab[MESH]|Wet Macular Degeneration/drug therapy/*economics[MESH] |