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Joint assessment of intended and unintended effects of medications: an example using vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration.

Levy AR, Szabo S, Briggs A, Pleil A, Davie A, Zlateva G, Javitt J - J Ophthalmol (2010)

Bottom Line: Net benefits decline with increasing baseline rates of unintended effects.Interpretation.Net health benefits present a quantitative, potentially useful tool to assist patients and ophthalmologists in balancing the benefits and harms of interventions for age-related macular degeneration.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada B3H 1V7.

ABSTRACT
Objective. To estimate the net health benefits of pegaptanib and ranibizumab by considering the impact of visual acuity and unintended effects (cardiovascular and hemorrhagic events) on quality-of-life among persons with neovascular age-related macular degeneration. Methods. We designed a probabilistic decision-analytic model using published data. It employed 17 visual health states and three for unintended effects. We calculated incremental net health benefits by subtracting the harms of each medication from the benefit using the quality-adjusted life year (QALY). Results. In a hypothetical cohort of 1,000 75-year olds with new-onset bilateral age-related macular degeneration followed for ten years, the mean QALYs per patient is 3.7 for usual care, 4.2 for pegaptanib, and 4.3 for ranibizumab. Net benefits decline with increasing baseline rates of unintended effects. Interpretation. Net health benefits present a quantitative, potentially useful tool to assist patients and ophthalmologists in balancing the benefits and harms of interventions for age-related macular degeneration.

No MeSH data available.


Related in: MedlinePlus

Net health benefits accruing to patients with neovascular age-related macular degeneration when using vascular endothelial growth factor inhibitors according to age (years) at treatment initiation.
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Related In: Results  -  Collection


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fig2: Net health benefits accruing to patients with neovascular age-related macular degeneration when using vascular endothelial growth factor inhibitors according to age (years) at treatment initiation.

Mentions: In a hypothetical cohort of 1,000 patients with new onset bilateral neovascular age-related macular degeneration followed for ten years, the mean number of QALYs was 3.7 (95% CI, 3.5–4.0) for usual care, 4.3 (95% CI, 4.1–4.4) for pegaptanib, and 4.4 (95% CI, 4.2–4.5) for ranibizumab. Net health benefits declined with increasing age at treatment initiation, from approximately 5.0 (pegaptanib; 4.8–5.2) or 5.1 (ranibizumab; 4.9–5.2) QALYs for patients aged 65 years, to 2.9 (pegaptanib; 2.8–3.0) or 3.0 (ranibizumab; 2.8–3.1) for patients aged 85 years (Figure 2). Net health benefits, and incremental net health benefits, are presented in Table 3.


Joint assessment of intended and unintended effects of medications: an example using vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration.

Levy AR, Szabo S, Briggs A, Pleil A, Davie A, Zlateva G, Javitt J - J Ophthalmol (2010)

Net health benefits accruing to patients with neovascular age-related macular degeneration when using vascular endothelial growth factor inhibitors according to age (years) at treatment initiation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2836847&req=5

fig2: Net health benefits accruing to patients with neovascular age-related macular degeneration when using vascular endothelial growth factor inhibitors according to age (years) at treatment initiation.
Mentions: In a hypothetical cohort of 1,000 patients with new onset bilateral neovascular age-related macular degeneration followed for ten years, the mean number of QALYs was 3.7 (95% CI, 3.5–4.0) for usual care, 4.3 (95% CI, 4.1–4.4) for pegaptanib, and 4.4 (95% CI, 4.2–4.5) for ranibizumab. Net health benefits declined with increasing age at treatment initiation, from approximately 5.0 (pegaptanib; 4.8–5.2) or 5.1 (ranibizumab; 4.9–5.2) QALYs for patients aged 65 years, to 2.9 (pegaptanib; 2.8–3.0) or 3.0 (ranibizumab; 2.8–3.1) for patients aged 85 years (Figure 2). Net health benefits, and incremental net health benefits, are presented in Table 3.

Bottom Line: Net benefits decline with increasing baseline rates of unintended effects.Interpretation.Net health benefits present a quantitative, potentially useful tool to assist patients and ophthalmologists in balancing the benefits and harms of interventions for age-related macular degeneration.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada B3H 1V7.

ABSTRACT
Objective. To estimate the net health benefits of pegaptanib and ranibizumab by considering the impact of visual acuity and unintended effects (cardiovascular and hemorrhagic events) on quality-of-life among persons with neovascular age-related macular degeneration. Methods. We designed a probabilistic decision-analytic model using published data. It employed 17 visual health states and three for unintended effects. We calculated incremental net health benefits by subtracting the harms of each medication from the benefit using the quality-adjusted life year (QALY). Results. In a hypothetical cohort of 1,000 75-year olds with new-onset bilateral age-related macular degeneration followed for ten years, the mean QALYs per patient is 3.7 for usual care, 4.2 for pegaptanib, and 4.3 for ranibizumab. Net benefits decline with increasing baseline rates of unintended effects. Interpretation. Net health benefits present a quantitative, potentially useful tool to assist patients and ophthalmologists in balancing the benefits and harms of interventions for age-related macular degeneration.

No MeSH data available.


Related in: MedlinePlus