By Alexandra Demetriou
Researchers at the University of Southern California have developed an economic model to quantify the benefits of treating age-related macular degeneration (WAMD), the leading cause of blindness in Western countries. Their work marks a step forward in how ophthalmologists audit their practices to define the value of modern treatments both to patients and to society as a whole.
The study, led by Karen Mulligan, PhD from the Sol Price School of Public Policy and the USC Schaeffer Center for Health Policy & Economics, Seth Seabury, PhD, director of the Keck-Schaeffer Initiative for Population Health Policy and associate professor at the USC School of Pharmacy, and Mark Humayun, MD, PhD, Director of the Dr Allen and Charlotte Ginsburg Institute for Biomedical Therapeutics and Co-Director of the USC Roski Eye Institute, was published on November 14 in the Journal of the American Medical Association (JAMA). This research represents the first analysis to quantitatively compare the economic benefits of therapeutic injections for AMD to their costs and assess the value they provide to society. The researchers’ model showed that treating AMD can generate $ 5.1 billion to $ 8.2 billion in patient benefits and $ 0.9 billion to $ 3 billion in societal benefits over three years based on the value of visual gains alone –– not to mention other potential benefits such as reductions in medical expenses or burden on caregivers. These numbers are set to climb even more if future healthcare innovations can increase treatment initiation and adherence rates.
QUANTIFICATION OF THERAPEUTIC VALUE
Age-related wet macular degeneration is a progressive form of blindness caused by the abnormal growth of blood vessels under the retina. A molecule called vascular endothelial growth factor (VEGF) causes this blood vessel to form, and doctors can treat the disease with targeted therapy against this molecule to block blood vessel growth and restore sight in patients for up to five years. . Anti-VEGF therapy is largely successful when injected into the eye regularly, but many people with wAMD never initiate treatment, and studies based on Medicare beneficiaries have shown that about 53 to 58% of wAMD patients receiving treatment discontinue treatment within the first year.1.2 The cost, fear of discomfort associated with the injection process, and the time-consuming nature of follow-up care all contribute to this problem, prompting many physicians to modify treatment schedules to minimize the number of injections a patient has. must receive without significantly compromising efficiency.
Finding the balance between providing sufficient treatment and minimizing the burden on patients can be tricky, and so far this has been made even more difficult by the fact that no one has previously quantified the benefits of anti-drug therapy. VEGF provides patients and society in return for the costs associated with treatment. At a time when healthcare spending is growing at an unsustainable rate and policymakers seek to cut costs wherever possible, this highlights the importance of quantifying which therapies are most worth their investment.
Other specialties have started a movement to quantify the value of treatment and compare benefits and costs, which has prompted Humayun to help kick-start this paradigm shift in ophthalmology by partnering with public policy experts like Mulligan and Seabury to audit the field’s own practices.
AN IMPRESSIVE RETURN ON INVESTMENT
Humayun and his team began by browsing the scientific literature and accumulating model data from wAMD patients treated with anti-VEGF therapy.. They translated the changes in visual acuity of patients over time into ‘quality-adjusted life years’, which is an economic measure that reflects both the quantity and quality of years lived and which could be used as a measure. variable in the team’s economic model.
“Our model assumes that a person with perfect 20/20 vision has a quality of life valued at $ 150,000 for a single year,” says Mulligan, referring to a value commonly used in health economics. “For a person who is diagnosed with AMD, their vision is worse – reflecting this, their quality of life is valued at around $ 105,000 for just one year,” she continues. “However, if they are treated with anti-VEGFs, their vision gains translate to a value of almost $ 11,000 after a year. In other words, an AMD patient would be willing to pay $ 11,000. $ for the improvement of the quality of life associated with a better vision from the first year of anti-VEGF treatments ”, she summarizes.
The model reflected several treatment scenarios, all compared to a “No treatment” control group: patients in the “Less frequent injections” group who received about 8 injections per year, those in the “More frequent injections” group who received an average of 10, 5 injections per year (a number closer to treatment suggestions on the drug label) and several different treatment innovation scenarios to reflect the gains that could occur if more patients initiate and continue treatment.
After creating this model, the team used it to simulate a range of possible patient outcomes depending on each scenario and compared the benefits of each outcome to its associated costs.
Their findings overwhelmingly underscore the vast economic benefits that anti-VEGF therapies bring to patients and to society as a whole, even in light of the relatively high drug costs. For example, a single patient receiving less frequent injections over a five-year period could benefit from approximately $ 49,558 in economic gains, and a patient receiving more frequent injections during that period could benefit from a value of $ 84,873. in the benefits of a better quality of life.
The study further strengthens the case for an increase in the number of injections per year, provided patients respond well and experience significant visual gain from treatment. Their analysis shows that receiving less frequent injections brings in $ 873 million in value to the general population over three years, while more frequent injections add $ 2.1 billion to societal value in three years, even after. have taken into account the higher costs of performing more injections. Importantly, the study points out that innovations aimed at improving treatment adherence could generate $ 1.2 to $ 3.7 billion in additional patient benefits and $ 59 to 1.3 billion in value. societal compared to current treatment scenarios, highlighting the fact that when patients receive the necessary treatment, individuals and society as a whole can reap the rewards.
The researchers also demonstrated that if 100% of patients who needed treatment actually started treatment and only 6% dropped out per year (the dropout rate in clinical trial data), patients could benefit. 42% more than just improving treatment adherence and 89% more. that they do not benefit from the current model “Less frequent injections”. In fact, in this “best-case scenario” reflecting high rates of treatment use and adherence, the benefits over three years could reach $ 9.7 billion to $ 15.0 billion depending on whether patients receive fewer or fewer injections, respectively. more frequent.
Finally, the team pointed out that while politicians often scorn the high costs of anti-VEGF treatments (in 2015, Medicare Part B paid $ 3.0 billion between just two anti-VEGF drugs), the team showed that relying more on a cheaper type of an anti-VEGF drug known as bevacizumab could reduce costs for the general population by $ 1.8 to $ 2.2 billion over three years . Results like these underscore the importance of using economics to quantify the value of different therapies and auditing common ophthalmology practices to optimize how physicians approach treatment in a way that benefits patients. and to society as a whole.
Curtis LH, Hammill BG, Qualls LG et al. Treatment models for neovascular age-related macular degeneration: analysis of 284,380 medicare beneficiaries. Am J Ophthalmol. 2012; 153 (6): 1116-1124.e1. doi: 10.1016 / j.ajo.2011.11.032
Lad EM, Hammill BG, Qualls LG, Wang F, Cousins SW, Curtis LH. Anti-VEGF treatment models for age-related neovascular macular degeneration in Medicare beneficiaries. American Journal of Ophthalmology. 2014; 158 (3): 537-543.e2. doi: 10.1016 / j.ajo.2014.05.014