Table 3.
Model Results: 1-Year Treatment and Lifetime Treatment
| Treatment | Average Procedures, n |
Complications, Excluding Minor Complications, n* |
Total Time Spent With Blindness (Visual Acuity 20/200 or worse), y†‡ |
Total Time Spent With Stable or Improved Visual Acuity, y‡ |
Total Time Spent With ≥5 Letters of Visual Acuity Improvement, y‡ |
Total Time Spent With Visual Acuity 20/30 or better, y‡ |
Lifetime Costs, $ |
Lifetime QALYs |
ICER, $/QALY§ |
|---|---|---|---|---|---|---|---|---|---|
| 1-y treatment∥ | |||||||||
| Laser treatment plus triamcinolone |
2.9 laser treatments and 2.9 injections |
0.32 | 0.10 | 13.63 | 13.06 | 10.61 | 97 998 | 5.63 ¶ |
(Reference
strategy) ** |
| Laser treatment plus a VEGF inhibitor |
1.8 laser treatments and 8.2 injections |
0.11 | 0.03 | 13.76 | 13.28 | 10.57 | 104 973 | 6.19 | 12 410 |
| Monotherapy with a VEGF inhibitor |
8.3 injections | 0.05 | 0.02 | 13.74 | 13.17 | 9.64 | 106 213 | 6.16 | (Dominated) †† |
| Triamcinolone monotherapy | 1.8 injections | 0.13 | 0.12 | 11.94 | 3.21 | 0.66 | 167 162 | 4.33 ¶ | (Dominated) †† |
| No treatment | None | 0.00‡‡ | 0.12 | 12.42 | 0.00 | 0.00 | 169 469 | 4.58 | (Dominated) †† |
| Laser monotherapy | 1.9 laser treatments |
0.04 | 0.12 | 11.75 | 3.47 | 0.75 | 170 027 | 4.66 | (Dominated) †† |
| Lifetime treatment §§ | |||||||||
| Laser treatment plus triamcinolone |
2.9 laser treatments and 13.7 injections |
0.59 | 0.10 | 13.66 | 13.09 | 12.52 | 97 493 | 5.16 ¶ |
(Reference
strategy) ** |
| Laser treatment plus a VEGF inhibitor |
1.8 laser treatments and 40.6 injections |
0.33 | 0.03 | 13.79 | 13.33 | 12.46 | 126 082 | 6.24 | 26 477 |
| Monotherapy with a VEGF inhibitor |
40.7 injections | 0.27 | 0.01 | 13.78 | 13.27 | 12.26 | 133 126 | 6.23 | (Dominated) †† |
| Triamcinolone monotherapy | 12.6 injections | 0.45 | 0.12 | 12.70 | 3.44 | 0.85 | 162 831 | 3.73 ¶ | (Dominated) †† |
| Laser monotherapy | 6.3 laser treatments | 0.15 | 0.12 | 12.23 | 3.64 | 0.89 | 167 341 | 4.70 | (Dominated) †† |
| No treatment | None | 0.00‡‡ | 0.12 | 12.42 | 0.00 | 0.00 | 169 469 | 4.58 | (Dominated) †† |
ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life-year; VEGF = vascular endothelial growth factor.
Number of complications occurring during treatment, in excess of baseline.
Values were normalized to the no-treatment group to adjust for starting visual acuity distributions.
Undiscounted, over lifetime follow-up.
Relative to the next best alternative.
Treatment administered over 1 y, with subsequent lifetime follow-up.
Unlike in other strategies, the lifetime QALYs associated with triamcinolone therapies decrease in going from the 1-y treatment model to the lifetime model. This is due to an increased likelihood of glaucoma and cataract with lifetime treatment (see Complications section in the Supplement, available at www.annals.org, for further details).
Baseline comparator for calculation of ICER. Represents the reference point on the cost-effectiveness frontier (Figure 2).
Costs more and is less effective than another strategy.
Baseline defined by the number of complication events in the untreated (clinical observation) group.
Treatment administered over lifetime.