Use of discrete event simulation (DEM) to evaluate the clinical practices in neovascular age-related macular degeneration

PALMA SD; SCHLOTTMANN P; REAL J.P; LUNA J.D

INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE

ASSOC RESEARCH VISION OPHTHALMOLOGY INC

Lugar: Rockville, MD 20852; Año: 2017 vol. 58 p. 428 - 428

0146-0404

Purpose:To evaluate the outcomes and direct medical cost of different regimens treatment in managing nAMD.Methods:We developed a discrete event simulation model that reproducing the long-term evolution of 5000 patients with nAMD. The model allows calculation the cost-effectiveness of treatment of AMD with Ranibizumab in two different therapeutic regimens: pro re nata (PRN) and Treat and Extend (TAE). Ranibizumab at the price of Lucentis (U$2000) and Ranibizumab at the price of Accentix (U$380). Data on effectiveness, rate of visual loss without treatment,the vision-related quality of life, time with VEGF suppression and time to functional recurrence were identified through a systematic literature searches. Time horizons were 10 years. A third-party-payer perspective was employed. A discount rate of 3% per annum was considered for both costs and outcomes benefits.Result: Over ten years of simulated treatment show us that the use of TAE scheme implies a higher number of intravitreal doses, a smaller number of consultations and savings in the accomplishment of studies of OCT. Effectiveness associated with the RNB regimens, Treat and extend (TAE) and as-needed (PRN), were 4.83 and 4.71QALY, respectively. The cost associated with LUCENTIS TAE and PRN were U$149.722 and U$ 125.200. When the price of Ranibizumab is that of Accentix, the cost associated is U$56.540 and U$60.000. The sensitivity analysis shows that TAE can be considered cost-effective compared to PRN when the price of RNB is less than U$900.Conclusion: DEM is a useful tool in the analysis of clinical practices For this case,TAE is the most effective régimen and is cost effective when Accentix is used.