Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis writing committee

The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.

Design: Randomized, controlled, clinical trial.

Participants: Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.

Methods: Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.

Main Outcome Measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.

Results: The ICER at 3 years was $297 800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16 900; P <0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41 200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.53 and 0.74, respectively.

Conclusions: Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.

Original languageEnglish (US)
Pages (from-to)1855-1862
Number of pages8
JournalOphthalmology
Volume121
Issue number10
DOIs
StatePublished - Oct 1 2014

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Fluocinolone Acetonide
Panuveitis
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Random Allocation
Therapeutics
Uveitis
Health Care Costs
Hospitalization
Randomized Controlled Trials
Steroids
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis writing committee. / The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group.

In: Ophthalmology, Vol. 121, No. 10, 01.10.2014, p. 1855-1862.

Research output: Contribution to journalArticle

The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. / Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis writing committee. In: Ophthalmology. 2014 ; Vol. 121, No. 10. pp. 1855-1862.
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title = "Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis writing committee",
abstract = "Objective: To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.Design: Randomized, controlled, clinical trial.Participants: Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.Methods: Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.Main Outcome Measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.Results: The ICER at 3 years was $297 800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16 900; P <0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41 200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.53 and 0.74, respectively.Conclusions: Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.",
author = "{The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group} and Elizabeth Sugar and Holbrook, {Janet Teresa} and Kempen, {John H.} and Burke, {Alyce E.} and Drye, {Lea T.} and Jennifer Thorne and Thomas Louis and Douglas Jabs and Altaweel, {Michael M.} and Kevin Frick",
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T1 - Cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for noninfectious intermediate, posterior, and panuveitis writing committee

AU - The Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group

AU - Sugar, Elizabeth

AU - Holbrook, Janet Teresa

AU - Kempen, John H.

AU - Burke, Alyce E.

AU - Drye, Lea T.

AU - Thorne, Jennifer

AU - Louis, Thomas

AU - Jabs, Douglas

AU - Altaweel, Michael M.

AU - Frick, Kevin

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objective: To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.Design: Randomized, controlled, clinical trial.Participants: Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.Methods: Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.Main Outcome Measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.Results: The ICER at 3 years was $297 800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16 900; P <0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41 200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.53 and 0.74, respectively.Conclusions: Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.

AB - Objective: To evaluate the 3-year incremental cost-effectiveness of fluocinolone acetonide implant versus systemic therapy for the treatment of noninfectious intermediate, posterior, and panuveitis.Design: Randomized, controlled, clinical trial.Participants: Patients with active or recently active intermediate, posterior, or panuveitis enrolled in the Multicenter Uveitis Steroid Treatment Trial.Methods: Data on cost and health utility during 3 years after randomization were evaluated at 6-month intervals. Analyses were stratified by disease laterality at randomization (31 unilateral vs 224 bilateral) because of the large upfront cost of the implant.Main Outcome Measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) over 3 years: the ratio of the difference in cost (in United States dollars) to the difference in quality-adjusted life-years (QALYs). Costs of medications, surgeries, hospitalizations, and regular procedures (e.g., laboratory monitoring for systemic therapy) were included. We computed QALYs as a weighted average of EQ-5D scores over 3 years of follow-up.Results: The ICER at 3 years was $297 800/QALY for bilateral disease, driven by the high cost of implant therapy (difference implant - systemic [Δ]: $16 900; P <0.001) and the modest gains in QALYs (Δ = 0.057; P = 0.22). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.003 and 0.04, respectively. The ICER for unilateral disease was more favorable, namely, $41 200/QALY at 3 years, because of a smaller difference in cost between the 2 therapies (Δ = $5300; P = 0.44) and a larger benefit in QALYs with the implant (Δ = 0.130; P = 0.12). The probability of the ICER being cost-effective at thresholds of $50 000/QALY and $100 000/QALY was 0.53 and 0.74, respectively.Conclusions: Fluocinolone acetonide implant therapy was reasonably cost-effective compared with systemic therapy for individuals with unilateral intermediate, posterior, or panuveitis but not for those with bilateral disease. These results do not apply to the use of implant therapy when systemic therapy has failed or is contraindicated. Should the duration of implant effect prove to be substantially >3 years or should large changes in therapy pricing occur, the cost-effectiveness of implant versus systemic therapy would need to be reevaluated.

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