Table 2.

Base-Case Model Inputs^*

Characteristic	Base- Case Value	Range for Sensitivity Analysis	Distribution for Probabilistic Sensitivity Analysis	References
Starting age, y	63	40 to 70	Normal	21–31, 37
Hazard ratio (survival in patients with diabetic retinopathy)	2.20	1.36 to 3.60	Truncated normal (minimum of 1)	69 – 71
Complication risks
Arterial thromboembolic event
VEGF inhibitor (annual probability)	0.016	0.004 to 0.033	β	21–31, 38–48, 72, 73
Triamcinolone (annual probability)	0.014	0.004 to 0.054	β	21–31, 38–48, 72, 73
Laser (annual probability)	0.014	0.006 to 0.054	β	21–31, 38–48, 72, 73
Not receiving treatment (annual   probability)	0.014	0.006 to 0.054	β	21–31, 38–48, 72, 73
Mild to moderate glaucoma
VEGF inhibitor (annual probability)	0.050	0.04 to 0.06	β	21–31, 38–48, 72–74
Triamcinolone (annual probability)	0.450	0.40 to 0.50	β	21–31, 38–48, 72–74
Laser (annual probability)	0.046	0.03 to 0.06	β	21–31, 38–48, 72–74
Not receiving treatment (annual   probability)	0.046	0.03 to 0.06	β	21–31, 38–48, 72–74
Severe/uncontrolled glaucoma (from  mild to moderate glaucoma)
VEGF inhibitor (annual probability)	0.050	0.00 to 0.20	β	Clinical assumption
Triamcinolone (annual probability)	0.050	0.00 to 0.20	β	Clinical assumption
Laser (annual probability)	0.050	0.00 to 0.20	β	Clinical assumption
Not receiving treatment (annual   probability)	0.050	0.00 to 0.20	β	Clinical assumption
Cataract
VEGF inhibitor (annual probability)	0.067	0.05 to 0.07	β	21–31, 38–48, 72–74
Triamcinolone (annual probability)	0.314	0.15 to 0.33	β	21–31, 38–48, 72–74
Laser (annual probability)	0.062	0.05 to 0.07	β	21–31, 38–48, 72–74
Not on treatment (annual   probability)	0.062	0.05 to 0.07	β	21–31, 38–48, 72–74
Other major complications
VEGF inhibitor (probability per  injection)	0.004	0.000 to 0.004	β	21–31, 38–48, 72–74†
Triamcinolone (probability per   injection)	0.004	0.000 to 0.004	β	21–31, 38–48, 72–74†
Laser (probability per treatment)	0.020	0.000 to 0.050	β	21–31, 38–48, 72–74†
Not receiving treatment   (probability per month)	0.000	By definition	NA	NA
Other minor complications
VEGF inhibitor (probability per   injection)	0.059	0.00 to 0.08	β	21–31, 38–48, 72–74
Triamcinolone (probability per   injection)	0.100	0.00 to 0.15	β	21–31, 38–48, 72–74
Laser (probability per treatment)	0.090	0.00 to 0.15	β	21–31, 38–48, 72–74
Not receiving treatment   (probability per month)	0.000	By definition	NA	NA
Direct costs, $
Examinations and testing
Initial office visit	141.2 7	103.80 to 141.27	Normal	7, 8
Follow-up office visit	87.21	87.21 to 105.28	Normal	7, 8
OCT	99.34	90.00 to 110.00	Normal	7, 8
Fundus photography	133.1 9	115.00 to 145.00	Normal	7, 8
FA	252.9 3	225.00 to 275.00	Normal	7, 8
Treatment (per-treatment cost)
VEGF inhibitor
Ranibizumab (0.3 mg)	1194 00	1194.00 to 2437.00	Normal	7, 9, 10
Bevacizumab (1.25 mg)	42.58 .00	40.00 to 60.00	Normal	10
VEGF Trap-Eye (2 mg)	1961. 00	1800.00 to 2000.00	Normal	36
VEGF Trap-Eye (0.5 mg)	490.0 0	400.00 to 600.00	Normal	36
Triamcinolone (4 mg)	136.7 4	120.00 to 150.00	Normal	11
Laser	393.3 5	360.00 to 420.00	Normal	8
Complications
Arterial thromboembolic events
Acute cost, $	13 263.0 0	4900.00 to 49 000.00	Truncated normal‡	75 †
Recurrent cost, $/mo	4514 00	130.00 to 21 600.00	Truncated normal‡	75 †
Endophthalmitis, $
Intravitreal injection	309.8 9	250.00 to 350.00	Truncated normal‡	7, 8
Antibiotics	5.37	5.37 to 50.00	Truncated normal‡	7, 9
Vitrectomy	3300. 00	3300.00 to 3500.00	Truncated normal‡	7, 8
Major complications, $
Average for injection	2000. 00	0.00 to 3700.00	Truncated normal‡	7, 8
Average for laser	500.0 0	0.00 to 600.00	Truncated normal‡	7, 8
Glaucoma, $
Eye drops	50.00	20.00 to 300.00	Truncated normal‡	7, 9
Trabeculectomy	2194. 00	2000.00 to 2400.00	Normal	7, 8
Selective laser trabeculoplasty	503.5 9	400.00 to 600.00	Normal	7, 8
Cataract, $	2021. 00	1820 to 2220	Normal	7, 8
Minor complication, $	50.00	0.00 to 100.00	γ	7, 8
Indirect (time) costs, $
Annual costs of blindness§
Visual acuity 1	0.00	0.00	NA	56, 59, 60
Visual acuity 2	0.00	0.00 to 500.00	Truncated normal‡	56, 59, 60
Visual acuity 3	0.00	0.00 to 1000.00	Truncated normal‡	56, 59, 60
Visual acuity 4	2867. 00	1000.00 to 5000.00	Truncated normal‡	56, 59, 60
Visual acuity 5	2867. 00	1000.00 to 5500.00	Truncated normal‡	56, 59, 60
Visual acuity 6	4315. 00	1500.00 to 6000.00	Truncated normal‡	56, 59, 60
Annual caregiver costs∥
Visual acuity 1	267.4 1	0.00 to 500.00	Truncated normal‡	61, 62
Visual acuity 2	1621. 00	0.00 to 2000.00	Normal	61, 62
Visual acuity 3	4308. 00	2000.00 to 6000.00	Normal	61, 62
Visual acuity 4	4308. 00	2000.00 to 7000.00	Normal	61, 62
Visual acuity 5	13 727.0 0	8000.00 to 15 000.00	Normal	61, 62
Visual acuity 6	19 991.0 0	10 000.00 to 25 000.00	Normal	61, 62
Utility estimates ¶
DME alone
Visual acuity 1	0.80	0.76 to 0.92	β	58
Visual acuity 2	0.70	0.69 to 0.92	β	58
Visual acuity 3	0.66	0.66 to 0.92	β	58
Visual acuity 4	0.61	0.59 to 0.84	β	58
Visual acuity 5	0.57	0.57 to 0.78	β	58
Visual acuity 6	0.53	0.55 to 0.71	β	58
Arterial thromboembolic event
Acute utility decrement	−0.42	−0.24 to −0.90	β	75 †
Recurrent utility decrement	−0.29	−0.04 to −1.00	β	75 †
Other major complications
Acute decrement	−0.60	−0.30 to −0.70	β	76†, clinical assumption
Glaucoma (recurrent decrement)
Controlled/mild	−0.05	0.00 to −0.20	β	77 †
Uncontrolled/severe	−0.10	0.00 to −0.35	β	77 †
Cataract
Acute decrement	−0.20	0.00 to −0.50	β	77 †
Other minor complications
Acute decrement	−0.05	0.00 to −0.20	β	Clinical assumption

DME = diabetic macular edema; FA= fluorescein angiography; NA = not applicable; OCT = optical coherence tomography; VEGF = vascular endothelial growth factor.

^*Costs are reported in 2010 U.S. dollars

^†Additional references in Supplement (available at www.annals.org).

^‡In cases where values on a normal distribution would fall below 0, the distribution was truncated to a minimum value of 0.

^§Costs of blindness were obtained from reference 60. Estimates were derived from the costs of any Medicare service not related to eye care or performed by an ophthalmologist/optometrist on the basis of Medicare claims data. Costs were adjusted for potential confounders via multivariate regression modeling and calculated as the amount in excess of non–eye-related costs with normal vision. Highlighted costs of blindness included injury, depression, and skilled nursing/long-term care facility utilization.

^∥Caregiver costs were obtained from reference 61. Estimated hours per week of caregiver assistance were based on results of the Age-Related Macular Degeneration Health and Impact Questionnaire administered to a sample of age-related patients with macular degeneration. The cost of caregiver time was calculated as forfeited wages, from Consumer Price Index–adjusted U.S. Bureau of Labor Statistics hourly nonfarm, nonsupervisory seasonally adjusted wages (62).

^¶Utility decrements represent the amount by which the quality-of-life utility in a given state is lessened because of a complication. In the case of an acute decrement, the amount shown is subtracted from quality of life only in the cycle (month) in which the complication occurs; a recurrent decrement is applied every month (for complications with chronic effects, such as glaucoma or stroke).