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Treatment Options for Age-Related Macular Degeneration: A Budget Impact Analysis from the Perspective of the Brazilian Public Health System.

Elias FT, Silva EN, Belfort R, Silva MT, Atallah ÁN - PLoS ONE (2015)

Bottom Line: The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated.The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period.The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Oswaldo Cruz Foundation, Brasília, Distrito Federal, Brazil.

ABSTRACT

Background: Age-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system.

Objective: To conduct a budget impact analysis of three scenarios for the introduction of AMD treatments: all the medications (verteporfin, ranibizumab, and bevacizumab-the reference scenario), ranibizumab alone, and bevacizumab alone.

Methods: The basic assumption was that the Brazilian public health system would treat the entire target population with AMD aged > 70 years between 2008 and 2011. The size of the population of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procurement policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the reference scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analyses were run to check the robustness of the model.

Results: In four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 for bevacizumab, US$11,469.39 for ranibizumab, and US$4,376.28 for verteporfin. The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period. The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.

Conclusion: The introduction of bevacizumab for the treatment of AMD is recommended for the Brazilian Public Health System.

No MeSH data available.


Related in: MedlinePlus

Random-effects meta-analysis of AMD prevalence.
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pone.0139556.g001: Random-effects meta-analysis of AMD prevalence.

Mentions: Four studies [19 ––22] were included in the meta-analysis on AMD prevalence, which had some similarities with the Brazilian population: Latin American, Afro-descendants and white. We estimated a prevalence of 2.17 (95%CI 1.05 to 3.29) for persons aged 70–79 years and of 10.33 (95%CI 8.20 to 12.54) for persons aged≥ 80 years (Fig 1). Considering that the neovascular form of AMD would account for two-thirds of all cases of the disease, we estimated 1,136,349 individuals for the period 2008–2011 (Table 1).


Treatment Options for Age-Related Macular Degeneration: A Budget Impact Analysis from the Perspective of the Brazilian Public Health System.

Elias FT, Silva EN, Belfort R, Silva MT, Atallah ÁN - PLoS ONE (2015)

Random-effects meta-analysis of AMD prevalence.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4601689&req=5

pone.0139556.g001: Random-effects meta-analysis of AMD prevalence.
Mentions: Four studies [19 ––22] were included in the meta-analysis on AMD prevalence, which had some similarities with the Brazilian population: Latin American, Afro-descendants and white. We estimated a prevalence of 2.17 (95%CI 1.05 to 3.29) for persons aged 70–79 years and of 10.33 (95%CI 8.20 to 12.54) for persons aged≥ 80 years (Fig 1). Considering that the neovascular form of AMD would account for two-thirds of all cases of the disease, we estimated 1,136,349 individuals for the period 2008–2011 (Table 1).

Bottom Line: The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated.The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period.The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Oswaldo Cruz Foundation, Brasília, Distrito Federal, Brazil.

ABSTRACT

Background: Age-related macular degeneration (AMD) is a disease that causes reduced visual acuity and blindness. The new treatment options for AMD are not provided by the Brazilian public health system.

Objective: To conduct a budget impact analysis of three scenarios for the introduction of AMD treatments: all the medications (verteporfin, ranibizumab, and bevacizumab-the reference scenario), ranibizumab alone, and bevacizumab alone.

Methods: The basic assumption was that the Brazilian public health system would treat the entire target population with AMD aged > 70 years between 2008 and 2011. The size of the population of interest was estimated from official population projections and the prevalence of the disease was obtained from a systematic review. Medication prices were estimated by weighting their market values with correction factors to take account of the public procurement policy. The possibility of aliquoting bevacizumab was also considered. A panel of experts was consulted to estimate the market share of the different medications for the reference scenario. The incremental costs of the ranibizumab-alone and bevacizumab-alone scenarios compared to the reference scenario were calculated. Univariate sensitivity analyses were run to check the robustness of the model.

Results: In four years, the Brazilian public health system would have treated 1,136,349 individuals with AMD. The annual costs of treating one patient would have been US$476.65 for bevacizumab, US$11,469.39 for ranibizumab, and US$4,376.28 for verteporfin. The incremental cost of the ranibizumab-alone scenario would have been US$1,878,318,056.00 in four years, while the incremental cost for the bevacizumab-alone scenario would have been a reduction of US$4,978,326,359.00 (i.e., a cost saving) in the same period. The bevacizumab-alone option was found to represent a cost saving across sensitivity analyses.

Conclusion: The introduction of bevacizumab for the treatment of AMD is recommended for the Brazilian Public Health System.

No MeSH data available.


Related in: MedlinePlus