Verteporfin photodynamic therapy for neovascular age-related ...
Verteporfin photodynamic therapy for neovascular age-related ... Verteporfin photodynamic therapy for neovascular age-related ...
62 Results (3) – objective E60,000Annual cost (£)40,00020,0000–10 0 10 20 30 40 50 60 70 80 90 100Best VA in either eyeFIGURE 17 Scatterplot showing the annual cost of HSS resource use compared with better-seeing eye BCVA. Theregression line superimposed on a scatterplot of the raw data is derived from fitting the two-part model. Values of BCVA< 0 (–10 and –20) represent ‘counting fingers’ and ‘hand movements’ levels of vision respectively.–0.005Time from baseline (months)0 3 6 9 12 15 18 21 240Mean predicted change in HRQoL–0.010–0.015–0.020–0.025–0.030–0.035–0.040–0.045–0.050BSCPDTFIGURE 18 Mean predicted change in HRQoL at 3-monthly time points for VPDT vs BSC for eyes with predominantlyclassic lesions that would have been EFT. Predictions combine VPDT map of HRQoL and visual acuity with visual acuityfor VDPT treatment and placebo groups reported in the TAP study.TABLE 20 Incremental costs, QALYs and costs per QALY results (VPDT vs BSC)Item Year 1 Year 2 (Year 1 + 2)Incremental intervention costs (£) 2860 744 3604Incremental costs of HSS (£) –59 –92 –151Incremental total costs (£) 2884 630 3514Incremental QALY 0.00866 0.01212 0.02071Incremental cost/QALY (£) 333,000 52000 170,000
DOI: 10.3310/hta16060Health Technology Assessment 2012; Vol. 16: No. 663Sensitivity analysesThe sensitivity analyses found that the results were robust to the methodological assumptions anddata sources used in the base-case analysis (Table 21). The probability that VPDT is cost-effectiveis zero unless the willingness to pay for a QALY gain exceeds £100,000 per QALY (Figure 19). Thefurther sensitivity analyses showed that:(i) If the treatment frequency was taken from TAP rather than the VPDT cohort study, theincremental costs increased to £5946 and the cost per QALY rose to £288,000.(ii) If the pre–post BCVA difference from the cohort study was used rather than the differencebetween arms in the TAP trials, then the estimated QALY gain was higher (0.0212 vs 0.0207),but the cost per QALY gained still exceeded £150,000.(iii) If the relationships of cost and HRQoL with CS rather than BCVA were used, this led to asmall increase in QALY gain compared with the base case (0.0220 vs 0.0207), but again thecost per QALY exceeded £150,000.(iv) If the costs of BSC were 10-fold those assumed in the base case, the cost per QALY was£91,000.(v) If the difference in BCVA observed for VPDT compared with BSC at 2 years was maintaineduntil 5 years, the cost per QALY was £94,000.TABLE 21 Sensitivity analyses on incremental cost (£) per QALY for VPDT vs BSC according to different assumptionsSensitivity analysis Incremental QALY Incremental cost Incremental cost/QALY aBase case 0.02066 3514 170,000TAP study treatment frequency 0.02066 5946 288,000VPDT cohort study VA results 0.02122 3511 165,000Contrast and sensitivity map 0.02201 3412 155,00010-fold increase in BSC costs 0.02066 1891 91,000VA, visual acuity.a Values rounded to the nearest 1000.Probability PDT is cost-effective10.90.80.70.60.50.40.30.20.10£0 £50,000 £100,000 £150,000 £200,000 £250,000 £300,000Willingness to pay for a QALY gainFIGURE 19 Cost-effectiveness acceptability curve for VPDT vs BSC.© 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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- Page 80 and 81: 66 Discussion of resultsStrengths a
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- Page 104 and 105: 90 Appendix 1THE VERTEPORFIN PHOTOD
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DOI: 10.3310/hta16060Health Technology Assessment 2012; Vol. 16: No. 663Sensitivity analysesThe sensitivity analyses found that the results were robust to the methodological assumptions anddata sources used in the base-case analysis (Table 21). The probability that VPDT is cost-effectiveis zero unless the willingness to pay <strong>for</strong> a QALY gain exceeds £100,000 per QALY (Figure 19). Thefurther sensitivity analyses showed that:(i) If the treatment frequency was taken from TAP rather than the VPDT cohort study, theincremental costs increased to £5946 and the cost per QALY rose to £288,000.(ii) If the pre–post BCVA difference from the cohort study was used rather than the differencebetween arms in the TAP trials, then the estimated QALY gain was higher (0.0212 vs 0.0207),but the cost per QALY gained still exceeded £150,000.(iii) If the relationships of cost and HRQoL with CS rather than BCVA were used, this led to asmall increase in QALY gain compared with the base case (0.0220 vs 0.0207), but again thecost per QALY exceeded £150,000.(iv) If the costs of BSC were 10-fold those assumed in the base case, the cost per QALY was£91,000.(v) If the difference in BCVA observed <strong>for</strong> VPDT compared with BSC at 2 years was maintaineduntil 5 years, the cost per QALY was £94,000.TABLE 21 Sensitivity analyses on incremental cost (£) per QALY <strong>for</strong> VPDT vs BSC according to different assumptionsSensitivity analysis Incremental QALY Incremental cost Incremental cost/QALY aBase case 0.02066 3514 170,000TAP study treatment frequency 0.02066 5946 288,000VPDT cohort study VA results 0.02122 3511 165,000Contrast and sensitivity map 0.02201 3412 155,00010-fold increase in BSC costs 0.02066 1891 91,000VA, visual acuity.a Values rounded to the nearest 1000.Probability PDT is cost-effective10.90.80.70.60.50.40.30.20.10£0 £50,000 £100,000 £150,000 £200,000 £250,000 £300,000Willingness to pay <strong>for</strong> a QALY gainFIGURE 19 Cost-effectiveness acceptability curve <strong>for</strong> VPDT vs BSC.© 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 <strong>for</strong> Health.
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