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

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

Baltimore

Congreso; Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting 2017.; 2017

Purpose: To evaluate the outcomes and direct medical cost ofdifferent treatment regimens in managing nAMD.Methods: A discrete event simulation model was developedreproducing the long-term evolution of 5000 patients with nAMD.The model allows calculation the cost-effectiveness of treatment ofAMD with Ranibizumab in two different therapeutic regimens: prore nata (PRN) and Treat and Extend (TAE). Ranibizumab at the priceof 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 andtime to functional recurrence were identified through a systematicliterature searches.Time horizons were 10 years. A third-party-payer perspective wasemployed. A discount rate of 3% per annum was considered for bothcosts and outcomes benefits.Results: Over ten years of simulated treatment show us that theuse of TAE scheme implies a higher number of intravitreal doses, asmaller number of consultations and savings in the accomplishmentof studies of OCT. Effectiveness associated with the RNB regimens,Treat and extend (TAE) and as-needed (PRN), were 4.83 and4.71QALY, respectively. The cost associated with LUCENTISTAE and PRN were U$149.722 and U$ 125.200. When the price ofRanibizumab is that of Accentix, the cost associated is U$56.540 andU$60.000. The sensitivity analysis shows that TAE can be consideredcost-effective compared to PRN when the price of RNB is less thanU$900.Conclusions: DEM is a useful tool in the analysis of clinicalpractices For this case, TAE is the most effective régimen and is costeffective when Accentix is used.