Cost-effectiveness analysis of treatment options for geographic atrophy
Nimesh Patel, MD, Director of Pediatric Retina at Mass Eye and Ear, talks about a study he was part of that was presented at the 2024 AAO Annual Meeting titled, “Cost Effectiveness Analysis of Treatment Options for Geographic Atrophy.”
Question:
Can you discuss the design of the study and its findings?
Nimesh Patel, MD:
Our study assessed the cost-effectiveness of Izervay for the treatment of geographic atrophy compared to Syfovre. The rationale for this study is there’s been 2 recently approved treatments for geographic atrophy, and we wanted to determine, based on the clinical trial data, to see which drug may be more cost-effective. Because there is no change in visual acuity between these medications, we had to come up with novel metrics, including cost per area saved. What we found in these hypothetical models was that, over the lifetime of the patient, every-month treatment was less cost-effective than every-other-month. In terms of between the drugs, the most cost-effective was every-other-month Syfovre treatment instead of every-month Izervay.
Both of the patients were seen to be most cost-effective for extrafoveal lesions rather than the foveal lesions, which does make some sense that treating before the vision is gone is better. Just some general results: The cost to treat GA over 2 years is about 67,000, the cost per area was over 119,000 per mm2, and the lifetime costs are approximately 330,000. Overall, the analysis found a modest utility preservation with treatment, but these treatments are expensive overall. Both treatment arms demonstrated a linear increase in costs in relation to time, but a decreasing marginal gain. The treatment of GA with Izervay every other month was more cost-effective than every month. For extrafoveal lesions, Izervay was less cost-effective than Syfovre for every-other-month treatment. Some of the limitations of this study is assumptions are made for the lifetime analysis, and it’s really a hypothetical model. The model of atrophy cannot be singular fit to all types. There’s baseline lesion size and locations of lesions that may play a role. Further studies are needing to be done as we get more data to refine the model.
Question:
Why is it important to look at medication costs?
Nimesh Patel, MD:
One of the challenges we have in our current healthcare system is there is a lot of rising costs, particularly for these patients that may be on government insurance or government supplements, and that’s coming out of taxpayer dollars and potentially decreasing funds for our future generation to have the same benefits. What we’re trying to do is assess if these treatments are cost-effective overall and should be covered by insurance. It appears that, yes, they are cost-effective and there is a benefit. However, every-other-month treatment is more cost-effective than every-month, and that’s something to take into consideration, especially with the very marginal benefit for more frequent treatment.
Question:
How do you think this research might impact decision-making?
Nimesh Patel, MD:
I think in terms of looking at the utility very closely, it’s clear that extrafoveal treatment has a better cost-effectiveness and measure gain than subfoveal treatment, although there may still be a benefit there as well. Also, like we talked about, the every-other-month treatment was far better than the every-month treatment, so it seems that if you have a patient that’s extrafoveal, every other month may be a reasonable option, especially if you couple that with the possibility of the treatment burden. Then between the medications, it appears that Syfovre was more cost-effective than Izervay across the board, and that’s yet to be determined in the long run, but that’s based on the clinical trial data that we have. That may inform the decision-making of who to treat and when to treat if you have in mind on efficacy and overall utility.
This content is independent editorial sponsored by Astellas. Astellas had no input in the development of this content.
