TY - JOUR
T1 - Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis writing committee
AU - The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group
AU - Sugar, Elizabeth A.
AU - Holbrook, Janet T.
AU - Kempen, John H.
AU - Burke, Alyce E.
AU - Drye, Lea T.
AU - Thorne, Jennifer E.
AU - Louis, Thomas A.
AU - Jabs, Douglas A.
AU - Altaweel, Michael M.
AU - Frick, Kevin D.
N1 - Funding Information:
Financial Disclosure(s): Supported by collaborative agreements from the National Eye Institute (Dr. Jabs: U10EY014655 , Dr. Holbrook: U10EY014660 , and Dr. Altaweel: U10EY014656 ). Bausch & Lomb donated fluocinolone implants for participants randomized to receive implant therapy who were uninsured or otherwise unable to pay for implants or were located at a site where implants could not be purchased. Dr. Thorne received a Sybil B. Harrington Special Scholars award from Research to Prevent Blindness . A representative of the National Eye Institute participated in the conduct of the study, including the study design and the collection, management, analysis, and interpretation of the data, and in the review and approval of this manuscript.
Publisher Copyright:
© 2014 by the American Academy of Ophthalmology.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objective: To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.Design: Randomized, controlled, clinical trial.Participants: Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.Methods: Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.Conclusions: Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.Main Outcome Measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.Results: The ICER at 3 years was $297 800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16 900; P < 0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41 200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.53 and 0.74, respectively.
AB - Objective: To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.Design: Randomized, controlled, clinical trial.Participants: Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.Methods: Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.Conclusions: Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.Main Outcome Measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.Results: The ICER at 3 years was $297 800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16 900; P < 0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41 200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.53 and 0.74, respectively.
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U2 - 10.1016/j.ophtha.2014.04.022
DO - 10.1016/j.ophtha.2014.04.022
M3 - Article
C2 - 24908205
AN - SCOPUS:84908086534
SN - 0161-6420
VL - 121
SP - 1855
EP - 1862
JO - Ophthalmology
JF - Ophthalmology
IS - 10
ER -