Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis.

Michael Altaweel // Publications // Oct 01 2014

PubMed ID: 24908205

Author(s): Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group, Sugar EA, Holbrook JT, Kempen JH, Burke AE, Drye LT, Thorne JE, Louis TA, Jabs DA, Altaweel MM, Frick KD. Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis. Ophthalmology. 2014 Oct;121(10):1855-62. doi: 10.1016/j.ophtha.2014.04.022. Epub 2014 Jun 5. PMID 24908205

Journal: Ophthalmology, Volume 121, Issue 10, Oct 2014

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.

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.

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.

Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.