Cost of care for patients with age-related macular degeneration in Switzerland and cost-effectiveness of treatment with verteporfin therapy.

The cost-effectiveness of photodynamic therapy with verteporfin in the treatment of patients with predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration was investigated by a Markov Model over a time horizon of three years in Switzerland. This model describes patients moving between three levels of visual acuity (e.g., good vision, impaired vision, highly impaired vision) and death in terms of transition probabilities. Transition probabilities as well as effectiveness values were derived from a randomized, controlled, double-masked clinical trial. Effectiveness for verteporfin therapy and for placebo was calculated in terms of vision years: 1.068 and 0.494, respectively. Cost per level of visual acuity was assessed in ascending order by expert panels from a societal perspective. Cost strongly increased parallel with vision loss on a patient-per-year basis from 4683 CHF at good vision to 8443 CHF at impaired vision, and was highest with 15231 CHF at highly impaired vision. The model-calculated cost per visionyear were 14907 CHF for patients in the verteporfin therapy group, versus 21047 CHF for patients in the placebo group. The incremental cost per vision-year additionally saved through verteporfin therapy was 9624 CHF. The study demonstrated that greater effectiveness of verteporfin therapy versus placebo compensated for the cost of the therapy so that verteporfin therapy was clearly costeffective. Therefore, for the indicated patients with AMD that causes severe vision loss, verteporfin therapy can be recommended as the therapy of choice, on both clinical and economic grounds.