Table 2 Cost and utility parameters used in the model.
Cost/Utility | Point estimate | Probabilistic analysisa | Sources/Notes | |
|---|---|---|---|---|
Distribution | Parameters | |||
Treatment cost (list price) | ||||
Aflibercept 4.0 mg/0.1 ml | £816.00 | Gamma | μ = 96.036, σ = 8.497 | BNF 28/03/2023 bnf.nice.org.uk |
Brolucizumab 19.8 mg/0.165 ml | £816.00 | μ = 96.036, σ = 8.497 | ||
Faricimab 28.8 mg/0.24 ml | £857.00 | μ = 96.036, σ = 8.924 | ||
Ranibizumab (Lucentis) 2.3 mg/0.23 ml | £551.00 | μ = 96.036, σ = 5.737 | ||
Ranibizumab biosimilar (Ongavia) 2.3 mg/0.23 ml | £523.45b | μ = 96.036, σ = 5.451 | ||
Bevacizumab 1.25 mg | £50.00c | μ = 96.036, σ = 0.521 | NICE TA824 [17] | |
Standard threshold laser | £41.16 | μ = 96.036, σ = 0.429 | Lois et al. [25] | |
Subthreshold micropulse laser | £47.11 | μ = 96.036, σ = 0.491 | Lois et al. [25] | |
Administration cost for anti-VEGFs | ||||
Optical coherence tomography (applied to 100% of visits) | £101.804 | Gamma | μ = 96.036, σ = 1.060 | NHS reference costs 2019-20. Consultant led non-admitted face-to-face attendance, follow-up. Code 130 (ophthalmology). Assumption used in NICE TA294 [41]. |
Administration visit – outpatient (applied to 95% of visits) | £129.616 | μ = 96.036, σ = 1.350 | NHS reference costs 2019-20. Outpatient procedure. BZ87A minor vitreous retinal procedures. Assumption used in NICE TA294 [41]. | |
Administration visit - day case (applied to 5% of visits) | £660.838 | μ = 96.036, σ = 6.881 | NHS reference costs 2019-20. Day case procedure. BZ87A minor vitreous retinal procedures. Assumption used in NICE TA294 [41]. | |
Anti-VEGF administration per visit | £257.981 | Not applicable | Not applicable | Calculation based on the above inputs. |
Monitoring cost | ||||
Monitoring visit during treatment | £101.804 | Gamma | μ = 96.036, σ = 1.060 | NHS reference costs 2019-20. Consultant led non-admitted face-to-face attendance, follow-up. Code 130 (ophthalmology). Assumption used in NICE TA294 [41]. |
Monitoring visit post treatment | £38.344 | μ = 96.036, σ = 0.399 | £32 (2012-13) from Scanlon et al. [42] was inflated to 2019-20 prices. | |
Low vision cost per 3-monthly cycle | ||||
Healthcare costs for low vision | £421.609 | Gamma | μ = 25.003, σ = 16.862 | Régnier et al. [22] The yearly total cost of visual impairment (BCVA ≤ 35) is £17,326, minus the cost of residential care (£15,327), community care (£600) and low vision rehabilitation (£47), in alignment with the NHS perspective. The costs (from 2010-11) were inflated to 2019-20 prices and then adjusted to a 3-monthly cycle length. |
Utility for best seeing eye (treated eye) | ||||
BCVA: >85 | 0.860 | Beta | α = 88.711, β = 14.441 | Czoski-Murray et al. [29] The authors used contact lenses with varying central opacity to simulate different stages of AMD, with health states valued by members of the public. This approach might have led to an underestimation of utility in more severe vision loss and an overestimation of treatment effects. Nonetheless, it was considered the most appropriate source due to its widespread use in previous NICE TAs for DMO [8, 17, 18], its alignment with the NICE reference case, and its inclusion in the NICE AMD guideline [43]. |
BCVA: 76-85 | 0.860 | α = 527.426, β = 85.860 | ||
BCVA: 66-75 | 0.813 | α = 857.529, β = 197.242 | ||
BCVA: 56-65 | 0.802 | α = 648.965, β = 160.218 | ||
BCVA: 46-55 | 0.770 | α = 420.116, β = 125.489 | ||
BCVA: 36-45 | 0.760 | α = 189.396, β = 59.809 | ||
BCVA: 26-35 | 0.681 | α = 51.985, β = 24.351 | ||
BCVA: ≤25 | 0.547 | α = 19.128, β = 15.841 | ||
Utility for worst seeing eye (treated eye) | ||||
BCVA: >85 | 0.860 | Beta | α = 88.711, β = 14.441 | The utility value for BCVA > 85 in the worst seeing eye was set equal to the value for BCVA > 85 in the best seeing eye, as reported by Czoski-Murray et al. [29]. Similar to the approach used by Régnier et al. [22], a utility decrement of 0.1 was assumed between the best (BCVA > 85) and worst (BCVA ≤ 25) health states, with a linear decline assumed for calculating the utility values of the other states. |
BCVA: 76-85 | 0.860 | α = 527.426, β = 85.860 | ||
BCVA: 66-75 | 0.843 | α = 772.928, β = 143.587 | ||
BCVA: 56-65 | 0.827 | α = 603.521, β = 126.545 | ||
BCVA: 46-55 | 0.810 | α = 383.940, β = 90.060 | ||
BCVA: 36-45 | 0.793 | α = 177.631, β = 46.274 | ||
BCVA: 26-35 | 0.777 | α = 47.182, β = 13.567 | ||
BCVA: ≤25 | 0.760 | α = 19.363, β = 6.114 | ||
