Verteporfin photodynamic therapy for neovascular age-related ...

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4 Introductionof VPDT in routine clinical practice. 20,21 Understanding the relationships between visual functionand vision-specific and generic HRQoL was central to achieving these aims. 22The health and social service costs of neovascular (wet) age-relatedmacular degeneration and associated treatmentsNeovascular AMD is potentially associated with high costs to health services and society. 23–25Interventions for nAMD may improve HRQoL and reduce the costs associated with decliningvision. 26 Cost-effectiveness analysis (CEA) is a powerful tool to evaluate and prioritise healthcareinterventions according to their relative effectiveness and cost. In many publicly fundedhealth systems, policy-makers require CEA to assess whether or not a new intervention hassufficient gain to justify additional costs before recommending adoption. Decision-makers inpredominantly privately funded health systems have recently shown interest in using CEA. 27Previous CEAs of VPDT for nAMD have been contradictory. Some studies have reported thatVPDT is ‘highly cost-effective’ and others that it is ‘definitely not cost-effective’. 26,28 For CEAs toprovide a sound basis for decision-making, they must meet certain methodological standards. 15,29The previous CEA of VPDT did not meet these standards on three grounds. 19 Firstly, interventioncosts were based on treatment frequencies reported in the TAP trial, which are higher than thosefor routine practice. 3,20,30 Secondly, the HRQoL measures used took inappropriate preferenceweightings from patients with nAMD rather than generic measures such as the SF-6D that takehealth-state preferences from the general population. 19,31 Because CEAs are used to comparehealth gain across disease areas, the HRQoL measures used should weight different health statesaccording to valuations taken from the general population rather than any specific patient group,for example patients with AMD. Thirdly, costing studies have reported that, compared withthe general population, patients with AMD are more likely to use residential care and socialservices and to take antidepressants. 32,33 However, previous CEAs either ignored costs associatedwith vision loss or relied on expert opinion, rather than collecting appropriate patient-levelcosts. 19,26,32,33 The VPDT cohort study was commissioned to address some of these limitations.
DOI: 10.3310/hta16060Health Technology Assessment 2012; Vol. 16: No. 65Chapter 2Aims and objectivesThe overarching aim of the VPDT cohort study was to broaden the understanding of thepathogenesis of CNV and its treatment with VPDT through a longitudinal analysis ofoutcomes in patients undergoing VPDT for CNV.The a priori objectives of the study were set out in the manual of operations (see Appendix 1).These were:1. to estimate the prevalence and incidence of patients with CNV being referred photodynamictherapy (PDT) who meet the eligibility criteria for treatment2. to describe the clinical management of patients with CNV being referred for VPDT whomeet the eligibility criteria for treatment3. to characterise changes over time in clinical outcomes, self-reported visual functioning(SRVF), generic quality of life and the societal costs of illness in patients receiving VPDTwho meet the eligibility criteria for treatment4. to describe the relationship between clinical outcomes, SRVF and HRQoL5. to estimate incremental cost-effectiveness, cost–utility and cost impact on the NHS (usingdata estimated for objectives 1–4 of implementing VPDT in the NHS for patients who meetthe eligibility criteria for treatment.During the first year of the project and following review of progress by the Health TechnologyAssessment programme, but before any analyses of data collected in the study, theseobjectives were updated to characterise better the uncertainties experienced by the NICEappraisal committee:(a) Is VPDT in the NHS provided as in randomised trials?(b) Is ‘outcome’ the same in the NHS as in randomised trials?(c) Is ‘outcome’ the same for patients who would have been ineligible for randomised trials?(d) Is VPDT safe when provided in the NHS?(e) How effective and cost-effective is VPDT?These objectives will be referred to in sequence in the rest of the report.© Queen’s Printer and Controller of HMSO 2012. This work was produced by Reeves et al. under the terms of a commissioning contract issued by theSecretary of State for Health.
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FeedbackThe HTA programme and the a
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