Verteporfin photodynamic therapy for neovascular age-related ...

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60 Results (3) – objective E100NEIVFQ composite total score8060402000 10 20 30Best CS in either eye40 50FIGURE 16 Scatterplot showing the NEIVFQ composite total score compared with better-seeing eye CS. The fittedregression line (see Table 16) is superimposed on a scatterplot of the raw data.How cost-effective is verteporfin photodynamic therapy?Verteporfin photodynamic therapy and best supportive care costsData describing VPDT treatments were available for 4566 patients in year 1 and 1834 patientsin year 2 (Table 17). The mean number of VPDT treatments per patient was 2.4 in year 1, fallingto 0.4 in year 2. The mean intervention cost of VPDT was £3026 in year 1 and £845 in year 2.The main cost component was the drug cost, which, on average, was 60% of the year 1 costs. Thecorresponding mean intervention costs for BSC were £166 for year 1 and £101 for year 2, givingincremental intervention costs of £2860 and £744 respectively.Health and social services use and costs related to vision lossHealth and social services and BCVA costs were available for a total of 3435 visits in 1764patients. As in the case of HRQoL data, most resource use questionnaires were completed inassociation with visits at 0, 6 and 12 months (Table 18). All visits with data were included in theanalysis. Only about 10% of patients reported using a health service, such as an unscheduledlow-vision appointment or seeing their GP, while < 0.5% of patients reported moving into anursing home, residential home or sheltered accommodation (Table 19). The mean annual totalcosts related to the patients’ eye conditions were low (approximately £300) relative to the VPDTintervention costs. Although the highest cost item was social service costs, the mean cost for thisitem was driven by the 1% of patients who received high levels of support from social servicehome carers costing > £3500 per year.There was a negative relationship between BCVA and annual HSS cost. Figure 17 shows thatthe gradient of this relationship, like that for HRQoL, was shallow. For example, for a five-letterdecrease in BCVA for patients with baseline of 50 letters, the predicted increase in mean annualcosts was about £28. For those patients who used a service, a five-letter decrease in BCVA wasassociated with a statistically significant increase in mean annual costs of £111 (95% CI ~£48 to~£174). This association between BCVA and SF-6D was combined with the differential decline inBCVA from baseline for the VPDT and placebo groups in TAP to derive differences in HRQoLbetween VPDT and BSC at 3-monthly intervals (Figure 18). 30
DOI: 10.3310/hta16060Health Technology Assessment 2012; Vol. 16: No. 661Cost-effectivenessThere was a small reduction in vision-related HSS costs following VPDT compared with BSCbecause of the smaller vision loss (year 1: mean costs of £320 for BSC group vs £260 for VPDTgroup; year 2: £382 vs £290). This reduction in vision-related costs offsets the additional costs ofthe intervention only to a small extent, and the incremental total costs of VPDT were positive(Table 20). The incremental QALYs for VPDT versus BSC were positive but small (Table 20). Thebase-case cost-effectiveness results showed that combining the small positive incremental QALYSgained for VPDT with the relatively high additional costs gave a cost per QALY of £170,000 over2 years (i.e. £3514/0.0207).TABLE 17 Mean resources used for interventions and associated costs (£) per patient for VPDT in year 1 (≤ 350 days)and year 2 (> 350 and ≤ 715 days)ItemYear 1 (n = 4566) Year 2 (n = 1834)Mean SD Mean SDVPDT resource useVPDT treatment visits 2.41 1.17 0.43 0.81Follow-up visits 1.30 1.02 1.59 1.25VPDT costs (£)FA 591 152 325 234Verteporfin and disposables 2074 1003 365 698VPDT treatment visit 272 132 48 92Follow-up visit 87 69 107 83Total 3026 1182 845 944TABLE 18 Distribution of visits for which visual function and resource use data were availableDuration of follow-up (months)Parameter0 3 6 9 12 > 12 TotalResource use and BCVA 1350 136 848 171 528 402 3435Resource use and CS 1276 96 764 127 466 356 3085TABLE 19 The percentage of patients using each HSS item, unit costs (£) and HSS costs (£)Item % using service in last 3 months Unit cost Mean (SD) annual cost per patient (£)Low vision appointment 9.96 83 51.2 (259.2)Visits to GP 10.88 44 22.1 (70.5)Social services 1.14 35 129.0 (1531)Day centre 1.21 32 26.3 (256)Nursing home stay 0.06 648 19.6 (812)Residential care 0.12 443 26.8 (785)Sheltered housing 0.20 140 14.8 (328)Antidepressant use 0.52 10 0.64 (8.8)Other NA NA 10.0 (53)Total NA NA 297 (2078)NA, not applicable.© 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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DOI: 10.3310/hta16060Health Technol
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xExecutive summaryretreat on criter
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xiiExecutive summaryof data, with i
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2 Introductionon-going or new clini
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4 Introductionof VPDT in routine cl
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Page 80 and 81: 66 Discussion of resultsStrengths a
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Page 84 and 85: 70 Discussion of resultsOur analyse
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Page 88 and 89: 74 Discussion of resultsVPDT. It is
Page 98 and 99: 84 References16. Stelmack J. Qualit
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Page 102 and 103: 88 References83. Margrain TH. Minim
Page 104 and 105: 90 Appendix 1THE VERTEPORFIN PHOTOD
Page 106 and 107: 92 Appendix 11. Overview of Manual
Page 108 and 109: 94 Appendix 1And, if also collectin
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110 Appendix 1The Verteporfin Photo
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112 Appendix 1• Additional clinic
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116 Appendix 1level of benefit from
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118 Appendix 1• comparison of num
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120 Appendix 110.6 Sub-group analys
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122 Appendix 112. Data issues12.1 D
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124 Appendix 113. Organisation13.1
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126 Appendix 114. References[1] Ref
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128 Appendix 1Barnes RM, Gee L, Tay
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130 Appendix 1Appendix 1: Classifyi
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132 Appendix 1Liverpool re-treatmen
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134 Appendix 1Service StructurePlea
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136 Appendix 1Has your photographer
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138 Appendix 1There are many differ
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140 Appendix 1testing on vision tes
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142 Appendix 1something to do with
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144 Appendix 1College of Ophthalmol
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146 Appendix 1Appendix 5:Protocol f
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152 Appendix 1Appendix 6:Protocol f
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158 Appendix 1
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166 Appendix 1Appendix 9:Site imple
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170 Appendix 1Dos and Don’tsDosDo
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174 Appendix 1Appendix 11: Recommen
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176 Appendix 1ADVERSE REACTION AND
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178 Appendix 1acute Trust; note tha
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180 Appendix 1Ophthalmologistrespon
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192 Appendix 3manufacturer’s pers
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FeedbackThe HTA programme and the a
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