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

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

Congreso; XLVIII REUNION ANUAL DE LA ASOCIACION ARGENTINA DE FARMACOLOGIA EXPERIMENTAL; 2016

ASOCIACION ARGENTINA DE FARMACOLOGIA EXPERIMENTAL

Neovascualar Age-related Macular Degeneration (nAMD) is the leading cause of severe visual loss in the developed world. Intravitreal anti vascular endothelial growth factors (anti-VEGFs) are effective but require substantial resource burden.Since the initiation of anti-VEGF therapy, different treatment regimens have been developed to attempt provide comparable visual result,but with a fewer number of injections or visits.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 two different therapeutic regimens: pro re nata (PRN) and Treat and Extend (TAE). The simulation was performed using 3 available drugs: Ranibizumab (RNB),Bevacizumab (BVZ) and Aflibercept (AFL). 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. The rate of adherence of patients to the controls and the time delay in access to drugs was obtained from the database of local patient studies.Result:On ten years of simulated treatment, costs associated with the BVZ regimens,TAE and PRN, were U$26236 and U$20636, with 4,30 and 3,91QALYs,respectively.Cost associated with RNB TAE and RNB PRN,were U$102750 and U$ 71139, with 4.36 and 3.95 QALY, respectively.Finaly, the costs associated with the AFL regimens TAE and PRN,were U$79283 and U$76658, with 4.49 and 4.06 QALY respectively.TAE obtain the better therapeutic results regardless of the drug used. TAE can be considered cost-effective compared to PRN when the drug used is BVZ and AFB. Conclusion:DEM is a useful tool in the analysis of clinical practices For this case,TAE is the most cost effective régimen except where RNZ is used.